Process and Systems of Trauma and Multi-casualty incidents

Define trauma

Injury occurring due to external source of energy transferring to the body faster than body can sustain and dissipate it

Define major trauma

When injury is likely to result in permanent disability or death

When and how should you use the Major Trauma Triage Decision tool/tree, and how do you access it?

Whenever you go to a trauma patient to:

• See if they meet any indicator to convey to major trauma centre

  • If yes, convey to closest MTC

  • If not, take to local ED

• Document reasoning using this tool on ePCR

Access on JRCALC:

• Dashboard

• Time Critical Emegrencies

• Scroll down to tool (red banner)

Define Mechanism of Injury (MOI), how to establish it and what it can inform?

• Sum of all physical forces that is exerted on the body which results in an injury.

• Can help inform:

  • What type of injuries

  • Severity of injuries

E.g., if can see an RTC with two vehicles head on travelling at 60mph, consider c-spine, spinal, concussion, abdo, chest, leg injuries at 120mph of force

E.g. jumping out of 1st floor, ?leg and pelvic injuries vs jumping out of 10th floor, major poly trauma and TCA

• Establish by reading the scene + gathering a history about what has happened

What is the difference between relative and absolute entrapment?

• Relative: injury is entrapping them, e.g. broken leg so can’t get out of vehicle

• Absolute: part of body is trapped under/within the object itself, e.g. crashed under tyre or building

What are some special considerations for patients that may not trigger the trauma tree, and what action should you take?

• A patient over 55

• Pregnant patient over 20 weeks

• Patient’s taking anti-coagulants or know bleeding/clotting disorders

• Morbidly obese patients

• Paediatrics under 12

• Your judgement

Call CHUB/HEMS/APP to consult

What are laws of physics associated with trauma?

• Kinetic energy

  • Faster + Heavier = more energy

• Conservation of energy

  • Energy cannot be created or destroyed (will go through to body)

• Newton’s first and second laws of motion

  • Body at rest will remain at rest unless acted on by outside force

  • Force object exerts is product of mass times acceleration

  • (e.g. car v car head on is both speeds added)

Describe the ten-second triage, the triage bag and actions for 1st, 2nd and 3rd onscene

• Ten second triage can be done by all responders, using the ten second triage card. Has 4 tags:

  • P1

  • P2

  • P3

  • Not breathing

• The triage bag is the red bag that contains the ten-second triage card, triage tags and immediate intervention equipment

  • 1st onscene - declare incident/call for backup, go through patients and do 10 second triage on each. Crew mate will await further resources to direct care

  • 2nd onscene - Scene survey and casualty care

  • 3rd onscene - Establish casualty clearing area

Describe the secondary triage for multiple casualty incidents

• Secondary to Life Saving interventions and the ten second triage - on-scene commander for LAS will decide on whether to do this or not

• Undertaken by Clinical Responders only

• For use at casualty clearing points or clearing stations rather than in situ

Describe the METHANE reporting mechanism

• Provides initial communication an details at a major incident

  • M - Major/Significant incident declared

  • E - Exact location

  • T - Type of incident

  • H - Hazards known or potential

  • A - Access and egress for vehicles

  • N - Number of casualties

  • E - Emergency services required

Describe the windscreen report reporting mechanism

Describing to Red Base exactly what you see in front of you from within your vehicle

• Press priority on radio

• Give EOC callsign and CAD number

• Tell them exactly what you see

Follow this with a methane report when you can

Describe the ATMIST and CATMIST handover models

ATMIST - used for handover in trauma

• A - age

• T- time of injury

• M - mechanism of injury

• I - injuries

• S - signs and symptoms

• T - treatment/immediate needs

CATMIST - used for trauma blue call

• C - callsign and cad

• A - age of patient

• T - time of injury

• M - mechanism of injury

• I - injuries

• S - signs and symptoms

• T - treatment given

When would you use ATMIST vs SBAR?

ATMIST for trauma patients

SBAR for medical patients