Epidemiology of trauma
- Trauma is the commonest cause of death in young adults
- Road traffic accidents each year in UK result in:
- 320,000 injuries
- 40,000 serious injuries
- 3,400 death
- Up to 30% of prehospital deaths may be preventable
- Prehospital care is important and is the start of the 'trauma chain'
- Philosophy of prehospital care varies between countries
- In USA basic resuscitation is performed at the scene
- This has been described as 'scoop and run'
- In France, mobile intensive care units often attend the scene of an accident
- This has been described as 'stay and play'
Picture provided by Mr. J C Campbell, Derriford Hospital, Plymouth
Initial action
- Potential problems at scene of accident
- Hostility of environment
- Lack of familiarity with surroundings
- Intrusive onlookers
- Assess safety of yourself and any casualties
- Make the accident site as safe as possible before assessing any casualties
- Determine the nature of accident and likely mechanism of injuries
- At road traffic accidents
- Determine number, direction and types of vehicles involved
- Degree of intrusion of damages vehicles
- Whether occupants were wearing seatbelts
Indications of potential significant trauma
- Penetrating injury to chest and abdomen
- Two or more proximal long bone fractures
- Burns involving more than 15% of body surface area
- Burns to face and airway
- Evdience of high-energy impact
- Fall more than 6m
- Crash speed greater than 20 mph
- Inward deformity of car of more than 0.6 m
- Rearward displacement of front axle
- Ejection of passenger from vehicle
- Rollover of vehicle
- Death of another car occupant
- Pedestrian hit at great than 20 mph
- Abnormal physiological variables
Picture provided by Joanne Rubin, Santa Clara County, California, USA
Prehospital resuscitation
- Should follow same principles as that in hospital
- Will need to be adapted to circumstances
- Airway management can be difficult
- Can often be maintained with basic measures
- Intubation without anaesthesia and rapid sequence induction is ill advised
- Can induce vomiting and raised intracranial pressure
- The cervical spine should be immobilized with a hard collar
- Oxygen should be given
- Haemorrhage should be controlled with direct pressure
- If casualty is entrapped ensure good venous access before releasing from vehicle
- Fluid resuscitation should be give to a systolic blood pressure of 90 mmHg
- If venous access difficult consider 'scoop and run' rather than delay transfer
- Analgesia can be achieved with Entonox or ketamine
- Entonox is contraindicated if possibility of:
- Pneumothorax
- Basal skull fracture
- Extrication requires close co-ordination between medical and fire services
- Casualty should be 'packaged for transport'
- This will require hard collar, head blocks, limb splints, scoop stretcher or vacuum mattress
Bibliography
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