The document provides guidance on the initial assessment and management of trauma patients. It emphasizes that the golden hour refers to time to definitive treatment, not time in transport or the ED. For critical patients, EMS has just 10 minutes to provide lifesaving interventions. The primary survey involves assessing the patient's airway, breathing, circulation, disability and exposure to identify and treat life threats. Oxygenation and control of hemorrhage are top priorities. Only after life threats are addressed should providers begin the more detailed secondary exam and assessment. Rapid transport to the appropriate facility is critical for trauma patients.

1. Barry Kidd 2010Barry Kidd 2010 11
Initial Assessment andInitial Assessment and
Management of TraumaManagement of Trauma

2. 2Barry Kidd 2010
IntroductionIntroduction
Golden Hour

Time to reach operating room
(or other definitive treatment)

NOT time for transport to ED

NOT time in Emergency Department

3. 3Barry Kidd 2010
IntroductionIntroduction
EMS does NOT have a Golden Hour
EMS has a Platinum Ten Minutes

4. 4Barry Kidd 2010
IntroductionIntroduction
Patients in their Golden Hour must:

Be recognized quickly

Have only immediate life threats
managed

Be transported to an APPROPRIATE
facility

5. 5Barry Kidd 2010
IntroductionIntroduction
Survival depends on assessment skills
Good assessment results from

An organized approach

Clearly defined priorities

Understanding available resources

6. 6Barry Kidd 2010
Size-UpSize-Up
Begins with Dispatch info
Safety
Scene
Situation
Report your size-up

Additional support or resources

Critical vs non-critical patient

7. 7Barry Kidd 2010
Size-Up on ApproachSize-Up on Approach
Safety, Scene, SituationSafety, Scene, Situation

Gut feeling,, how does the scene look?

Hazards?

How many patients? Where are they?

What do the mechanism of injury & kinematics
suggest?

What does the environment tell you, do you need
special needs/resources?

What do you require immediately?

Report your size-up if it is irregular and you need
more help.

8. 8Barry Kidd 2010
Size-Up on ApproachSize-Up on Approach
What is your radio size-up of this
incident?

9. 9Barry Kidd 2010
Initial Assessment (Primary Survey)Initial Assessment (Primary Survey)
Find and correct life threats
Most obvious or dramatic injury usually is
NOT what is killing the patient!
If life-threat is present, CORRECT IT!
If it can’t be corrected

Support oxygenation, ventilation, perfusion

TRANSPORT!!
SICK or NOT SICK?SICK or NOT SICK?

10. Barry Kidd 2010Barry Kidd 2010 1010
Initial Assessment (PrimaryInitial Assessment (Primary
Survey)Survey)
With critical trauma you mayWith critical trauma you may
never get beyond the primarynever get beyond the primary
surveysurvey

11. 11Barry Kidd 2010
Initial Assessment (Primary Survey)Initial Assessment (Primary Survey)
C-Spine Control with airway
You don’t need a C-collar yet

Return head to neutral position

Stabilize without traction

Axially unload spine

12. 12Barry Kidd 2010
Initial Assessment (Primary Survey)Initial Assessment (Primary Survey)
Airway with C-Spine Control

Noisy breathing is obstructed breathing
But all obstructed breathing is not noisy

Manpower intensive task

13. 13Barry Kidd 2010
Initial Assessment (Primary Survey)Initial Assessment (Primary Survey)
Airway with C-Spine Control

Anticipate airway problems with
Decreased level of consciousness
Head trauma
Facial trauma
Neck trauma
Upper thorax trauma
Severe Burns to any of these areas

Open, Clear, Maintain

14. 14Barry Kidd 2010
Initial Assessment (Primary Survey)Initial Assessment (Primary Survey)
Breathing

Is oxygen getting to the blood?
Is air moving?
Is it moving adequately?
Is it moving at an adequate rate?

15. 15Barry Kidd 2010
Initial Assessment (Primary Survey)Initial Assessment (Primary Survey)
Breathing

Look

Listen

Feel

16. 16Barry Kidd 2010
Initial Assessment (Primary Survey)Initial Assessment (Primary Survey)
Breathing

Oxygenate immediately if:Oxygenate immediately if:
Decreased level of consciousness
Shock
Severe hemorrhage
Chest pain
Chest trauma
Dyspnea
Respiratory distress
Multi-system trauma

17. 17Barry Kidd 2010
Initial Assessment (Primary Survey)Initial Assessment (Primary Survey)
Breathing

If you think about giving oxygen, GIVEIf you think about giving oxygen, GIVE
IT!!IT!!

18. 18Barry Kidd 2010
Initial Assessment (Primary Survey)Initial Assessment (Primary Survey)
Breathing

Consider assisted ventilations if:
Respirations <12
Respirations >32
Tidal volume decreased
Respiratory effort increased

19. 19Barry Kidd 2010
Initial Assessment (Primary Survey)Initial Assessment (Primary Survey)
Breathing

If you can’t tell if ventilations are
adequate, they aren’t!!

20. 20Barry Kidd 2010
Initial Assessment (Primary Survey)Initial Assessment (Primary Survey)
Breathing

If ventilations or respiration are
compromised in the trauma patient,
expose, palpate, auscultate the chest.

21. 21Barry Kidd 2010
Initial Assessment (Primary Survey)Initial Assessment (Primary Survey)
Circulation

Is the heart beating?

Is there serious external bleeding?

Is the patient perfusing?
How do we know?How do we know?

22. 22Barry Kidd 2010
Initial Assessment (Primary Survey)Initial Assessment (Primary Survey)
Circulation

Does patient have radial pulse?Does patient have radial pulse?
Absent radial = systolic BP < 80Absent radial = systolic BP < 80

Does patient have carotid pulse?Does patient have carotid pulse?
Absent carotid = systolic BP < 60Absent carotid = systolic BP < 60

23. 23Barry Kidd 2010
Initial Assessment (Primary Survey)Initial Assessment (Primary Survey)
Circulation

No carotid pulse?
Extricate
CPR
Run!!!!

Survival rate from cardiac arrest
secondary to trauma is very low

24. 24Barry Kidd 2010
Initial Assessment (Primary Survey)Initial Assessment (Primary Survey)
Circulation

Serious external bleeding?
Direct pressure (hand, bandage)
Tourniquet as last resort

All bleeding stops eventually!

25. 25Barry Kidd 2010
Initial Assessment (Primary Survey)Initial Assessment (Primary Survey)
Circulation

Is patient perfusing?
Cool, pale, moist skin = shock, Unable to
Perfuse Oxygen
Capillary refill > 2 sec = shock UPO
Restlessness, anxiety, combativeness =
shock UPO

If ? internal hemorrhage, QUICKLYIf ? internal hemorrhage, QUICKLY
expose, palpate abdomen, pelvis,expose, palpate abdomen, pelvis,
thighsthighs

26. 26Barry Kidd 2010
Initial Assessment (Primary Survey)Initial Assessment (Primary Survey)
Disability (CNS Function)

Level of consciousness = Best brain
perfusion sign

Use AVPU initially

Check pupils
The eyes are the window of the CNS

27. 27Barry Kidd 2010
Initial Assessment (Primary Survey)Initial Assessment (Primary Survey)
Disability (CNS Function)

Decreased LOC =
Brain injury
Hypoxia
Hypoglycemia
Shock

NEVER think drugs, alcohol, or
personality first

28. 28Barry Kidd 2010
Initial Assessment (Primary Survey)Initial Assessment (Primary Survey)
Expose and Examine

You can’t treat what you don’t find!

If you don’t look, you won’t see!

Remove ALL clothing from critical
patients ASAP

Avoid delaying resuscitation while
disrobing patient

Cover patient with blanket when
finished

29. Barry Kidd 2010Barry Kidd 2010 2929
Initial Assessment (PrimaryInitial Assessment (Primary
Survey)Survey)
A blood pressure or an exactA blood pressure or an exact
respiratory or pulse rate is NOTrespiratory or pulse rate is NOT
necessary to tell that your patient isnecessary to tell that your patient is
critical !!!!!critical !!!!!

30. Barry Kidd 2010Barry Kidd 2010 3030
Initial Assessment (PrimaryInitial Assessment (Primary
Survey)Survey)
If the patient looks sick, he’sIf the patient looks sick, he’s
sick!!!sick!!!

31. 31Barry Kidd 2010
Primary ResuscitationPrimary Resuscitation
Treat as you go!Treat as you go!
Aggressively correct hypoxia andAggressively correct hypoxia and
hypovolemia.hypovolemia.

32. 32Barry Kidd 2010
Primary ResuscitationPrimary Resuscitation
Immobilize C-spine (manual & rigid collar)
Keep airway open
Oxygenate
Rapidly extricate to long board (SMR)
Begin assisted ventilation with BVM
Expose & Protect from exposure
Transport
Establish IVs en route if protocol allows
Reassess and early notification enroute

33. Barry Kidd 2010Barry Kidd 2010 3333
Primary ResuscitationPrimary Resuscitation
Never delay transport of a critical
patient to start an IV!!!

34. Barry Kidd 2010Barry Kidd 2010 3434
Primary ResuscitationPrimary Resuscitation
Minimum Time On Scene
Maximum Treatment In Route
Have a PLAN!

35. 35Barry Kidd 2010
Secondary SurveySecondary Survey(Detailed/Rapid Trauma)(Detailed/Rapid Trauma)
History and Physical Exam
You WILL get here with MOST trauma patients
Perform ONLY after primary survey is completed
and life threats corrected
Do NOT hold critical patients in field for
secondary survey

36. 36Barry Kidd 2010
Secondary SurveySecondary Survey(Detailed/Rapid Trauma)(Detailed/Rapid Trauma)
History

Chief complaint
What the PATIENT says problem is
Not necessarily what you see

37. 37Barry Kidd 2010
Secondary SurveySecondary Survey(Detailed/Rapid Trauma)(Detailed/Rapid Trauma)
History

SAMPLE history
S = Signs and symptoms
A = Allergies
M = Medications
P = Past medical history
L = Last oral intake
E = Events leading up to incident

38. 38Barry Kidd 2010
Secondary SurveySecondary Survey(Detailed/Rapid Trauma)(Detailed/Rapid Trauma)
Physical Exam

Stepwise, organized

Every patient, same way, every time

Superior to inferior; proximal to distal

Look--Listen--Feel

39. 39Barry Kidd 2010
Secondary SurveySecondary Survey(Detailed/Rapid Trauma)(Detailed/Rapid Trauma)
Physical Exam

Assessment of extremitiesAssessment of extremities MUSTMUST include:include:
PulsesPulses
Skin colorSkin color
Skin temperatureSkin temperature
Capillary refillCapillary refill
Motor functionMotor function
Sensory functionSensory function

40. 40Barry Kidd 2010
Secondary SurveySecondary Survey(Detailed/Rapid Trauma)(Detailed/Rapid Trauma)
Physical Exam

Use your stethoscopeUse your stethoscope

Listen to patient’s chestListen to patient’s chest

Most frequently missed areasMost frequently missed areas
BackBack
MouthMouth
Neuro examNeuro exam

41. Barry Kidd 2010Barry Kidd 2010 4141
Definitive Field CareDefinitive Field Care
Performed ONLY on stable
patients

42. 42Barry Kidd 2010
Definitive Field CareDefinitive Field Care
Packaging

Bandaging

Splinting
If a patient is critical, all fractures are to be
stabilized simultaneously by securing
patient to board

43. 43Barry Kidd 2010
Definitive Field CareDefinitive Field Care
Transport

Stable patients can receive attention for
individual injuries before transport

Reassess carefully for hidden problems

If patient becomes unstable at any time,
TRANSPORT

Closest APPROPRIATE facility

44. 44Barry Kidd 2010
Definitive Field CareDefinitive Field Care
Communication

Radio report
Brief
Concise
No more than 90 seconds air time

Written run report

If it isn’t documented, it wasn’t done

45. 45Barry Kidd 2010
Definitive Field CareDefinitive Field Care
Reevaluation en route

Ventilation and perfusion status

Vital signs every five minutes

Continued management of identified problems

Continued reassessment for unidentified
problems

46. 46Barry Kidd 2010
QUESTIONSQUESTIONS

47. 47Barry Kidd 2010