1. Introduction to Emergency Medical Care 1
Advance Preparation
Research related multimedia links for illustration purposes.
Reach out to the local trauma center/trauma service for educational resources.
Invite a trauma surgeon.
Prepare equipment for scenario purposes.
Invite assistant instructors and programmed patients to assist with scenario sessions.

2. OBJECTIVES
32.1 Define key terms introduced in this chapter. Slides 12, Describe the considerations for teamwork, timing, and transport decisions in assessing and managing patients with multisystem trauma or multiple trauma. Slides 18–19
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3. OBJECTIVES
32.3 Discuss the physiologic, anatomic, and mechanism of injury criteria for determining patient severity with regard to trauma triage and transport decisions. Slides 13–16
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4. OBJECTIVES
32.4 Recognize special patient considerations that increase the patient’s priority for transport, such as age, anti-coagulation bleeding disorders, burns, time-sensitive extremity injuries, end-stage renal disorders requiring dialysis, and pregnancy. Slides 13–16
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5. OBJECTIVES
32.5 Discuss general principles of multisystem trauma management. Slides 20– Describe the purposes of trauma scoring systems. Slides 24–26

6. MULTIMEDIA Slide 27 Emergency: Gunshot Wound Video
Slide 28 Multiple System Injuries in Front-end Collisions Video
Slide 29 Mechanism of Injuries in Vehicle Collisions Video
These videos appear later in the presentation; you may want to preview them prior to class to ensure they load and play properly. Click on the links above in slideshow view to go directly to the slides.

7. How to balance the critical trauma patient’s need for prompt transport against the time needed to treat all the patient’s injuries at the scene
How to determine the severity of the trauma patient’s condition, priority for transport, and appropriate transport destination
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8. How to select the critical interventions to implement at the scene for a multiple-trauma patient
How to calculate a trauma score

9. Topics Multisystem Trauma Managing the Multisystem Trauma Patient
Planning Your Time: Plan 60 minutes for this chapter.
Multisystem Trauma (30 minutes)
Managing the Multisystem Trauma Patient (30 minutes)
Note: The total teaching time recommended is only a guideline.

10. Multisystem Trauma Teaching Time: 30 minutes
Teaching Tips: Use examples and scenarios to describe the trauma decision-making process. Discuss the Center for Disease Control Trauma Triage Guidelines. Discuss the guidelines of your local trauma center. Integrate this type of decision making into scenarios throughout class. Make it more than a one-time lesson.

12. Multisystem Trauma
Patient with one or more injuries serious enough to affect more than one body system
Points to Emphasize: The multisystem trauma patient has one or more injuries that are serious enough to affect more than one body system. Care for multisystem trauma is different from that for isolated trauma. Teamwork, timing (moving patient to definitive care as soon as possible), and transport (decision about appropriate destination) are essential.
Discussion Topics: Define multisystem trauma. Discuss how the treatment and transportation of a multisystem trauma patient is different from that of an isolated trauma patient.
Knowledge Application: Have students work in small groups. Ask each group to discuss the different roles that would be necessary to treat and transport a multisystem trauma patient. What would be the components of teamwork?
Critical Thinking: Is there isolated trauma that requires similar decision making and teamwork when compared to multisystem trauma? Give examples.

13. Determining Patient Severity
Physiologic criteria
Anatomic criteria
Mechanism of injury
Points to Emphasize: EMTs must look at actual physiologic injuries, anatomic locations, and mechanism of injury to adequately judge patient severity and transport priority. Special considerations, such as age and underlying medical condition, may alter the initial severity decisions.
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14. Determining Patient Severity
Physiologic criteria
Altered mental status (GCS <14): head injury
Hypotension (systolic <90mmHg): shock, internal bleeding
Abnormally slow respiratory rate: head injury, later stages of shock
Abnormally high respiratory rate: shock
Talking Points: Geriatric patients will not compensate for shock efficiently. Children also respond differently and may benefit from prompt transport to a pediatric specialty facility. Other illnesses or conditions, such as pregnancy or chronic illnesses, can weaken the body’s ability to respond, necessitating a heightened response.
Knowledge Application: Using local geography, describe a trauma scene. Ask students to make severity decisions and to plan appropriate transportation.

15. Anatomic Criteria
Injury to specific a body part/area requiring immediate surgical intervention
Injuries to the head and chest
Multiple musculoskeletal injuries
Amputations
Severely mangled extremities
Pelvic injuries
Discussion Topic: What special considerations might alter the decision-making process when dealing with a trauma patient?
Class Activities: Hand out four written scenarios as a take-home assignment. Ask students to read each scenario and then to write out an initial treatment and transport plan.

16. Mechanism of Injury
In absence of anatomic or physiologic signs, MOI is considered if severe
Fall
High-risk auto crash
Automobile-pedestrian crash
Motorcycle crash
Discussion Topic: Describe the information needed to judge the severity of a multisystem trauma patient.
Class Activity: Discuss local trauma resources. Where are the local trauma centers? What transport options are present?
Knowledge Application: Use a programmed patient and simulate trauma scenarios. Have groups of students practice assessment, decision making, and teamwork.

17. Managing the Multisystem Trauma Patient
Teaching Time: 30 minutes
Teaching Tips: Use multimedia graphics to demonstrate multisystem trauma scenes. The scenario in the chapter is a helpful example of a trauma scene. Use it as a basis for discussion or as a framework for other scenarios. Relate this lesson to previous lessons. Discuss the context of airway management, bleeding control, and spinal immobilization in multisystem trauma patients. Describe how the primary assessment will guide these steps. Add context to scenarios. By now, students will be familiar with standardized skill sheets. Begin to teach flexibility and adaptation by using atypical situations.

18. Preparing for Multisystem Trauma Patients
Practice with crew: determine roles
En route to call, review roles each member of the crew will have
Point to Emphasize: The best way to prepare for multisystem trauma is to practice and develop teamwork before the call.
Discussion Topic: Describe the process of preparing for a multisystem trauma situation. What steps can you take before the call?
Knowledge Applications: Have students work in small groups. Ask each group to preplan multisystem trauma. Discuss roles and teamwork and compare notes among groups. Using the same groups and a programmed patient, create a multisystem trauma patient scenario. Discuss whether preplanning helped and how students might preplan differently.

19. Scene Safety Scene safety is paramount
Different trauma is associated with different dangers
Auto crash will have passing traffic
Penetrating trauma—assailant may still be on the scene
Point to Emphasize: Scene safety considerations are an essential component of multisystem trauma management.
Discussion Topic: What safety hazards might be present at a multisystem trauma scene?
Class Activity: Use multimedia graphics to illustrate unusual trauma scenes. Discuss examples that show how traditional response and treatment might not be appropriate. Demonstrate flexibility.

20. Treating Multisystem Trauma
Follow priorities determined by primary assessment
Attend to threats to life
Reassess what to treat on scene and what needs definitive care
Call hospital so they can prepare
Points to Emphasize: The best way to prepare for multisystem trauma is to practice and develop teamwork before the call.
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21. Treating Multisystem Trauma
Postpone vitals
Alert hospital
Talking Points: Depending on your primary assessment, you may postpone taking vital signs until you are en route to the hospital. Alert hospital that you are on your way, and give them the information you have so that they can prepare the trauma team. As you reassess your patient in the vehicle, call the hospital as necessary to update the vital signs.
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22. Treating Multisystem Trauma
Limit scene treatment
Suction airway
Insert oral or nasal airway
Restore patent airway
Ventilate with bag-valve mask
Administer oxygen
Control bleeding
Immobilize patient
Point to Emphasize: Limit scene treatment to airway management, breathing control, administering high-concentration oxygen, controlling bleeding. and spinal immobilization.
Discussion Topic: What interventions are reasonable to conduct on scene with a multisystem trauma patient?
Knowledge Application: Use programmed patients to practice multisystem trauma scenarios. Time “on-scene interventions” and discuss decision making.
Critical Thinking: How might transport time affect the interventions completed at a scene? Might there be more on-scene interventions in the event of a long transport time? Might there be fewer?

23. Expect the Unexpected Adapt to situation
Do what is necessary to ensure an open airway
Perform urgent or emergency moves as necessary
If part of patient’s body is not accessible, assess part of the body you can reach
Point to Emphasize: The EMT must adapt to unusual circumstances in multisystem trauma management. Expect the unexpected.
Discussion Topic: Use examples to discuss why it is important to be flexible and to adapt at a multisystem trauma scene.

24. Trauma Scoring Numerical rating system for trauma
Assigns number to certain patient characteristics to create a score
Objectively describes severity
Helps determine transport to a trauma center or local hospital
Helps trauma centers evaluate the care of similar patients

25. Revised Trauma Score (RTS)
Components
Glasgow Coma Scale (GCS)
Systolic blood pressure
Respiratory rate
Follow local protocol for use of the trauma scoring system
Do not let it interfere with patient care
Talking Points: Up to four points are assigned per category. The lower the score, the more seriously injured the patient is and the less likely to survive, even with excellent care. Manage airway problems and control other immediate threats to life before trying to use a score.

26. Sample RTS Form

27. Emergency: Gunshot Wound Video
Video Clip
Emergency: Gunshot Wound
Discuss the importance of a complete assessment to identify any wounds.
Why can’t an EMT accurately determine a bullet’s path in a patient’s body?
What might an EMT mistake for an exit wound?
Discuss the different sizes of entrance wounds made by different types of guns.
Click here to view a video on the subject of treating gunshot wounds.
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28. Multiple System Injuries in Front-end Collisions Video
Video Clip
Multiple System Injuries in Front-end Collisions
What injuries frequently occur when a patient goes down and under during a front-end collision?
Discuss the use of restraints in preventing multisystem injuries.
What additional challenges does an EMT face when patients sustain multi-system injuries?
Click here to view a video on the subject of trauma due to front-end collisions.
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29. Mechanism of Injuries in Vehicle Collisions Video
Video Clip
Mechanism of Injuries in Vehicle Collisions
What types of injuries should you anticipate in a patient who has been involved in a head-on collision?
Why are neck injuries common in rear-end collisions?
Discuss the types of injuries that you would expect if a patient has been ejected from a vehicle involved in a rollover.
Why should you consider the mechanism of injury when doing a scene size-up?
Click here to view a view a video on the types of injuries in motor vehicle collisions.
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30. Chapter Review

31. Chapter Review
Multisystem trauma is a serious condition in which two or more major body systems are injured or affected.
Recognizing multisystem trauma, triaging properly, transporting promptly, and choosing the correct destination are vital for the survival of your patient.
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32. Chapter Review
The CDC has issued guidelines for trauma triage and transport. These are a guide and should be used in conjunction with your protocols.
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33. Chapter Review
The revised trauma score (RTS) is one method of classifying trauma patients by severity and includes the Glasgow Coma Score (GCS), systolic blood pressure, and respiratory rate.

34. Remember
Your primary assessment should determine whether your patient is seriously injured or potentially seriously injured.
Limit scene treatment to life-threatening conditions.
The “golden hour” begins from the time of trauma.
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35. Remember
Use patient severity (physiologic criteria, anatomic criteria, MOI) to decide whether to transport to a trauma center or local hospital.

36. Questions to Consider
Is my patient seriously injured or potentially seriously injured?
Should I expedite my scene time?
What is the most appropriate transport destination for my patient?
Talking Points: There are many different types of trauma situations, and decision-making in each will be determined by the conditions.

37. Critical Thinking
A patient was involved in a car crash with significant intrusion into the area where the patient was sitting. The patient is alert and complains of pain in the ribs. Pulse: 96 and regular; respirations: 30 and adequate; blood pressure: 100/62; pupils: equal and reactive; skin: cool and dry.
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38. Critical Thinking
Your partner says the patient is stable and could be easily transported to the community hospital nearby. You think the patient should be transported to the trauma center. How would you justify your decision to your partner?
Talking Points: Since the patient complains of pain in the rib area and the potential for considerable blunt injury trauma due to the crash, you should be alert for unseen internal injuries and the possibility that the patient may need critical care that is better supplied at a specialized trauma center than at a community hospital.

39. Please visit Resource Central on www. bradybooks
Please visit Resource Central on to view additional resources for this text.
Please visit our web site at and click on the mykit links to access content for this text. Under Instructor Resources, you will find curriculum information, lesson plans, PowerPoint slides, TestGen, and an electronic version of this instructor’s edition. Under Student Resources, you will find quizzes, critical thinking scenarios, weblinks, animations, and videos related to this chapter—and much more.