Trauma Wk One - P&S Surveys & Trauma Systems

Trauma Triage Immediate Life Threat Criteria & Care

- Airway compromise or threat

- Severe bleeding that cannot be compromised

> closest trauma center, esclate care & signal 1. notify ARV.

Trauma Triage Vital Signs Criteria & Care

- SpO2 <90

- RR <10 or >30

- HR <60 or >120

- BP <90

- GCS <13

> closest trauma center within 60 minutes, esclate care & signal 1. notify ARV & consider HEMS if time to hospital is >60min

Trauma Triage Pattern of Injury Criteria & Care

- Penetrating Trauma (EXCEPT ISOLATED SUPERFICIAL LIMB INJURIES)

- Blunt trauma > serious injury to a single body region, or more than one

- Limb amputation or limb threat

- Suspected spinal chord injury or fracture

- Burns >20% TBSA

- Suspected resp tract burns

- Serious crush injury

- Major compound fracture

- Fracture to two or more long bones

- Pelvis fracture

Highest level of trauma service within 60min, escalate care, HEMS is >60min out, signal ONE

Trauma Triage Mechanism + Vunerability Criteria & Care

- motor cyclist impact >30km/hr

- high speed MCA >60km/hr

- pedestrian impact

- ejection from vehicle

- prolonged extrication

- fall from >3m

- struck on the head object from >3m

- explosion

AND over 55, pregnant, or significant underlying condition (hypertension, obesity, CCF cont/uncont, symptomatic COPD, IHD, renal issues)

Closest trauma service, escalation of care

Trauma Service List

MAJOR TC (Adult >16yrs)

- Royal Melbourne

- The Alfred

MTS Paed (<16yrs)

- Royal Childrens

Metro Trauma Centres

- austin health (A+Paed)

- box hill (A+Paed)

- the northern (A+Paed)

- monash medical (A+Paed)

- dandenong (A+Paed)

- frankston (A+Paed)

- Maroondah (ADULT ONLY)

- St VIncents (ADULT ONLY)

- Western Hospital Footscray

Regional TC

- Geelong, Hamilton, Warrambool

- Ballarat, Horsham

- Bendigo, Mildura

- Albury, Shepparton, Wangaratta

- Traralgon

VSTORM

Victorian State Trauma Outcomes Registry and Monitoring Group - they gather & interpret information about causes of traumatic injury and treatment from trauma centres across Victoria. Aim is to reduce preventable deaths. (in vic since 2001)

Improved Functional Outcomes for Major Trauma Patients in a Regionalized, Inclusive Trauma System

Despite an annual decline in mortality, risk-adjusted functional outcomes improved over time, and cases managed at MTS (level-1 trauma centers) demonstrated better functional outcomes. The findings provide early evidence that this inclusive, regionalized trauma system is achieving its aims.

Paed Trauma Criteria Vitals 0-3mnths

HR <100 - <180

RR >60

BP <50

SPO2 <90%

GCS <15

Paed Trauma Criteria Vitals 4-12mnths

HR <100 - <180

RR >50

BP <60

SPO2 <90%

GCS <15

Paed Trauma Criteria Vitals 1-4yrs

HR <90 - <160

RR >40

BP <70

SPO2 <90%

GCS <15

Paed Trauma Criteria Vitals 5-11yrs

HR <80- <140

RR >30

BP <80

SPO2 <90%

GCS <15

Paed Trauma Criteria Vitals 12-15yrs

HR <60- <130

RR >30

BP <90

SPO2 <90%

GCS <15

What is a 'Major Trauma' ?

Includes all trauma patients with injury as their principal diagnosis who meet the following criteria:

- death after injury

- injury severity score >12

- admission to intensive care for more than 24 hours

- urgent surgery for intracranial, intrathoracic or intraabdominal injury, or fixation of pelvic or spinal fractures

- injury being the principal diagnosis & satisfying any of the victorian state trauma registry patient inclusion criteria

Global Trauma Epidemiology

- 4.4MIL people die each year due to unintentional and violence related injuries

- Persons ages 5-29, top 3/5 causes of death are injury related

- injuries and violence are responsible for an estimated 10% of all years lived with disability

Global MVA Accident Vehicle Distribution Stats

- 25% 4 wheelers

- 30% powered 2/3 wheelers

- 5% bikes

- 21% pedestrians

- 19% other

Aussie Trauma Epidemiology

- 1,,824,454 ED presentations

- 575,345 hospitalisations

- 15,332 deaths

- 7.9% of total burden of disease

- 6.4% of healthcare spending

VIC Trauma Epidemiology 22-23

- 4235 major trauma patients hospitalised

- 513 in-hospital trauma deaths

- 2190 estimated trauma deaths

- 68.4% male

- 33.6% occur on weekends

- 51% 8am-4pm, 32% 4.01pm - 12am)

- 34% transport related

- 37% due to falls

- 5.5% cyclists

- 1.3% burns

- 37% at home

Viictorian Epi Stats

'Golden Hour'

The first hour after injury will largely determine a critically injured persons chances for survival

Trimodial Distribution of Deaths

Immediate: targeted with safety features/public health

Early: enhanced pre-hospital care + trauma systems

Late: specialist trauma care - massive reduction

Theoretical Model of an Ideal Trauma System

- advanced prehospital system

- registry research education

- centralised expertise

- expert Advice & retrieval

- satellite recieving centres

- early notification

- rapid transpirt platforms

- rapid identification & dispatch

When was ROTES established?

Review of Trauma & Emergency Services VIC was published in 1999, and established the need for a statewide trauma system, and formalised trauma centres.

Paramedics role in a Trauma case

patient assessment, triage, leadership & choice making, primary survey intervention, supportive management, resource allocation, communication

Four Trauma Triage Pathways

- Life threat

- Vital signs

- Pattern of Injury

- MOI + Vunerability

Three components of pre-hospital trauma triage

Vital signs, Anatomical, Mechanism

Clinical Approach Breakdown

- Dynamic Risk Assessment (throughout)

- Rapid Assessment (WOB, Circ to skin, Appearance) - SICK/NOT SICK

- Haemorrhage (identify & manage early. DP, DP Again, Arterial Pressure, CAT & Haemostatic Dressing)

- Response (AVPU)

- Airway + C-Spine (check for patency, listening for weird sounds) - collar?

- Breathing (Yes? No? Adequate? Manage if required)

- Circulation (Pulse?)

- Disability/Defib (pads on if needed)

- Exposure/Environment

- History (AMPLE + DOLORS), VSS, GCS RSA PSA

- Secondary Survey

Trauma Secondary Survey (HEAD)

- lacerations

- haematomas

- fractures

- mastoid/periorbital bruising (basal skull)

- feel for depressions, boggy masses & other irregularities

Trauma Secondary Survey (FACE)

- symmetry

- CSF from nose/ears

- foreign bodies in eyes

- iris & eye shape

- hyphema

- bruising under eyes

- conjunctival haemorrhage

- pupil size & reactivity

- mid-facial swelling

- upward gaze abaility

- nasal fracture

- alignment of bite

- oral swelling

- palpate bony margins of orbit, maxilla, nose & jaw

Potential Trauma Injuries (FACE)

- fractures (+basal skull & nose))

- high forces

- pressure changes

- TBI

- le forts fracture

- orbital floor fracture

- bleeding into the stomach

- lost teeth

Trauma Secondary Survey (NECK)

- lacerations

- perforations

- gross irregularities

- general pain

- trachea alignment

- wounds

- subcutaneous emphysema

- vein distension

Potential Trauma Injuries (NECK)

- spinal injury

- bone injury

- vessel perforation

Trauma Secondary Survey (CHEST/BACK)

- lacerations

- perforations

- bruising

- equal rise & fall

- paradoxical movements

- lung sounds present?

- wounds (blunt/penetrating)

- subcutaneous emphysema

- seatbelt signs

Potential Trauma Injuries (CHEST/BACK)

- lung contusions

- lung injury/pnemothorax

- large vessel perforations

- pericardial tamponade (FLUID IN HEART)

- Haemothorax

- Flail segment

- rib injuries

Trauma Secondary Survey (ABDOMEN)

- lacerations

- bruising

- perforations

- swelling/rigidity

- tenderness

- penetrating injuries

- genitalia injury

Potential Trauma Injuries (ABDO)

- underlying contusion

- vessel perforation

- internal haemorhhage

Trauma Secondary Survey (PELVIS + LEGS)

- pelvic symmetry (DO NOT SPRING)

- blood from urethra

- genital injury

- neurovasc obs

- deformity

- crepitus

- unnatural movement

- changes in strength & sensation

Potential Trauma Injuries (PELVIS & LEGS)

- fracture

- spinal injuries

Traumatic Arrest Guideline

OSCE vs ON ROAD Approach

OSCE: DRSAaBbCcHDE

ON ROAD: DR ABC Hh abc (D)E