2Introduction Golden Hour Time to reach operating room (or other definitive treatment)NOT time for transport to EDNOT time in Emergency Department
3Introduction EMS does NOT have a Golden Hour EMS has a Platinum Ten Minutes
4Introduction Patients in their Golden Hour must: Be recognized quickly Have only immediate life threats managedBe transported to an APPROPRIATE facility
5Introduction Survival depends on assessment skills Good assessment results fromAn organized approachClearly defined prioritiesUnderstanding available resources
6Size-Up Begins with Dispatch info Safety Scene Situation Report your size-upAdditional support or resourcesCritical vs non-critical patient
7Size-Up on Approach Safety, Scene, Situation Report your size-up How does the scene look?Hazards?How many patients? Where are they?What do the mechanism & kinematics suggest?Special Needs/Resources?Immediate actions required?Report your size-up
8Size-Up on ApproachWhat is your radio size-up of this incident?
9Initial Assessment (Primary Survey) Find and correct life threatsMost obvious or dramatic injury usually is NOT what is killing the patient!If life-threat is present, CORRECT IT!If it can’t be correctedSupport oxygenation, ventilation, perfusionTRANSPORT!!SICK or NOT SICK?
10Initial Assessment (Primary Survey) With critical trauma you may never get beyond the primary survey
11Initial Assessment (Primary Survey) Airway with C-Spine ControlYou don’t need a C-collar yetReturn head to neutral positionStabilize without tractionAxially unload spine
12Initial Assessment (Primary Survey) Airway with C-Spine ControlNoisy breathing is obstructed breathingBut all obstructed breathing is not noisyManpower intensive task
13Initial Assessment (Primary Survey) Airway with C-Spine ControlAnticipate airway problems withDecreased level of consciousnessHead traumaFacial traumaNeck traumaUpper thorax traumaSevere Burns to any of these areasOpen, Clear, Maintain
14Initial Assessment (Primary Survey) BreathingIs oxygen getting to the blood?Is air moving?Is it moving adequately?Is it moving at an adequate rate?
26Initial Assessment (Primary Survey) Disability (CNS Function)Level of consciousness = Best brain perfusion signUse AVPU initiallyCheck pupilsThe eyes are the window of the CNS
27Initial Assessment (Primary Survey) Disability (CNS Function)Decreased LOC =Brain injuryHypoxiaHypoglycemiaShockNEVER think drugs, alcohol, or personality first
28Initial Assessment (Primary Survey) Expose and ExamineYou can’t treat what you don’t find!If you don’t look, you won’t see!Remove ALL clothing from critical patients ASAPAvoid delaying resuscitation while disrobing patientCover patient with blanket when finished
29Initial Assessment (Primary Survey) A blood pressure or an exact respiratory or pulse rate is NOT necessary to tell that your patient is critical !!!!!
30Initial Assessment (Primary Survey) If the patient looks sick, he’s sick!!!
31Primary Resuscitation Treat as you go!Aggressively correct hypoxia and hypovolemia.
32Primary Resuscitation Immobilize C-spine (manual & rigid collar)Keep airway openOxygenateRapidly extricate to long board (SMR)Begin assisted ventilation with BVMExpose & Protect from exposureApply and consider inflation of PASGConsider intubationTransportEstablish IVs enrouteReassess and early notification enroute
33Primary Resuscitation Never delay transport of a critical patient to start an IV!!!
34Primary Resuscitation Minimum Time On SceneMaximum Treatment In RouteHave a PLAN!
35Secondary Survey(Detailed/Rapid Trauma) History and Physical ExamYou WILL get here with MOST trauma patientsPerform ONLY after primary survey is completed and life threats correctedDo NOT hold critical patients in field for secondary survey
36Secondary Survey(Detailed/Rapid Trauma) Physical ExamStepwise, organizedEvery patient, same way, every timeSuperior to inferior; proximal to distalLook--Listen--Feel
37Secondary Survey(Detailed/Rapid Trauma) Physical ExamUse your stethoscopeListen to patient’s chestMost frequently missed areasBackMouthNeuro exam
38Secondary Survey(Detailed/Rapid Trauma) Physical ExamAssessment of extremities MUST include:PulsesSkin colorSkin temperatureCapillary refillMotor functionSensory function
39Secondary Survey(Detailed/Rapid Trauma) HistoryChief complaintWhat the PATIENT says problem isNot necessarily what you see
40Secondary Survey(Detailed/Rapid Trauma) HistoryAmple historyA = AllergiesM = MedicationsP = Past medical historyL = Last oral intakeE = Events leading up to incident
41Performed ONLY on stable patients Definitive Field CarePerformed ONLY on stable patients
42Definitive Field Care Packaging BandagingSplintingIf patient critical, all fractures stabilized simultaneously by securing patient to board
43Definitive Field Care Transport Stable patients can receive attention for individual injuries before transportReassess carefully for hidden problemsIf patient becomes unstable at any time, TRANSPORTClosest APPROPRIATE facility
44Definitive Field Care Communication Radio report Written run report BriefConciseNo more than 90 seconds air timeWritten run reportIf it isn’t documented, it wasn’t done
45Definitive Field Care Reevaluation en route Ventilation and perfusion statusVital signs every five minutesContinued management of identified problemsContinued reassessment for unidentified problems