BH 2

Trauma Tours and Triage Criteria

• Trauma Tour Eligibility
  • Patients are eligible for a trauma tour if:
  • The closest ED (Emergency Department) is greater than thirty minutes away.
  • Must not just report witnessing an arrest to initiate a tour.
• Trauma Tour vs. Medical Tour
  • Trauma tours are applicable in cases of severe physical injuries such as traumatic hemorrhage.
  • Prehospital management options to control bleeding are limited.
  • Blood products are not provided in the prehospital setting.
  • Medical tours are considered when it is possible for the patient to receive blood products soon after arrival at a hospital.
• PEA (Pulseless Electrical Activity) Conditions
  • Patients exhibiting PEA rhythms remain viable and merit transportation to hospitals if they can receive timely interventions.
  • Care should include keeping potential survivors within the window for hospital care.

Field Trauma Triage Guidelines

• Familiarity with Local Guidelines
  • Understanding the trauma triage criteria as per local protocols is crucial.
  • Example: In modifications like calling Orange for trauma in specific areas.
• Penetrating Trauma Considerations
  • Patients who are dead from penetrating trauma (e.g., gunshot or stab wounds) can still be taken to hospital if:
  • There are signs of life prior to extrication, and they are within thirty minutes of a lead trauma hospital.
  • Definition of Fully Extricated: If a patient is moved from a scene or vehicle by rescuers and displays any signs of life, they require transport.
• Clarification Scenarios
  • If a patient is removed from a vehicle and shows signs of life, they still need to go to the hospital.
  • If a patient is without signs of life at the scene, a trauma call is warranted regardless of location.
• Confusion Over Signs of Life
  • Scenarios where signs of life are noted after extrication but subsequently deteriorate must be approached with caution; if transport takes longer than expected (over thirty minutes), a tour may be appropriate.

Newborn Resuscitation (NRP)

• Age Definition
  • Focuses on newborns aged twenty-four hours or less, as outlined in the Neonatal Resuscitation Program (NRP).
• Importance of Positive Pressure Ventilation
  • Newborns respond better to ventilation than chest compressions or defibrillation.
  • Vital Signs to Monitor: Heart rate and respiration are primary; oxygen saturation is less crucial in the initial resuscitation process.
  • Contraindications to resuscitation include being dead or a gestational age of fewer than twenty weeks.
• Airway Management
  • Effective airway positioning is critical for ventilation efficacy.
  • Techniques: Utilize oral airways if necessary and ensure the airway is clear before attempting ventilation.
• Assessment Principles
  • Assess newborns for term gestation, breathing, and appearance using a pediatric assessment triangle.
• Resuscitation Process
  • Initial focus on maintaining airway, providing warmth, and beginning positive pressure ventilation to treat inadequate breathing.
  • If heart rate drops below sixty beats per minute after initial attempts, initiate CPR, and apply oxygen to the BVM during chest compressions.
  • Lack of response requires thorough evaluation and ongoing treatment to assess need for transportation to a hospital.

Cardiac Arrest and ROSC Care

• Fluid Management
  • Following ROSC, only fluid therapy is authorized for Prehospital Care Providers (PCPs) to restore blood pressure and perfusing organs, particularly in the presence of hypovolemia.
  • Established fluid bolus of ten mL/kg is recommended.
  • Monitor lung sounds to avoid fluid overload.
• Oxygenation Parameters
  • Oxygenation should be titrated to maintain saturation levels between 94% and 98%.
  • Avoid excess oxygen administration as it can cause vasoconstriction, complicating blood flow.
  • For ventilation, maintain end-tidal CO2 levels between thirty and forty mmHg.
• Considerations for Medications
  • Initiate ACLS protocol for suspected cardiac ischemia, noting that not all patients will show typical pain.
  • Use comprehensive patient assessments over limited symptom checks in guiding treatment decisions like administering ASA (aspirin).
  • Nitroglycerin requires prior ECG assessment to avoid complications with right ventricular involvement.

Pain Management Protocols

• Medication Options
  • Options include acetaminophen (Tylenol), non-steroidal anti-inflammatory drugs (NSAIDs), and toradol for patients over twelve years of age and who are not altered in consciousness.
  • Monitor for contraindications such as active internal bleeding or recent anticoagulant usage.
• Dosing Considerations
  • The specific recommended dosages are informed by age, weight, and medication history including previous doses of similar or class-effect drugs.

Antiemetic Approval Protocols

• Ondansetron and Gravol Usage
  • Ondansetron is the first-line treatment unless contraindications (e.g., use of apomorphine or prolonged QT syndrome) exist.
  • Gravol can be considered for patients under 65 years if ondansetron is ineffective or unavailable; patching is required for patients over 65 before medication administration.
• Documenting Decisions
  • Ensure to follow documentation protocols to distinguish between regular treatment and any exceptions that may complicate care such as refusals to go to hospitals or specific patient conditions.

Additional Clinical Protocols

• Documentation and Referrals
  • Emphasize the importance of thorough documentation, especially distinguishing between treat-and-discharge versus refusal of service.
  • Medics should remain aware of different protocols involved with community standards and ensure clear communication with base hospital protocols for unusual clinical scenarios.
• Substances and Toxins
  • Be aware of treatment approaches regarding patients presenting with suspected opioid overdoses, ensuring ventilation is prioritized before administering naloxone (Narcan) due to the inherent risk of reviving patients too abruptly.