PCP Recertification Trauma TOR

TOR - Overview Objectives Blunt Trauma Penetrating Trauma TOR Key Points Special Circumstances

TOR Objectives Given pre-course reading and Webinars, small group discussion of various case studies, a manikin, and medical equipment, the paramedic will be able to: Describe mechanism of injuries that could result in blunt or penetrating traumatic arrest, Explain the differences between the Blunt Trauma TOR and the Penetrating Trauma TOR. Summarize the evidence for either transporting or terminating resuscitation of traumatic arrest patients based on the conditions of the directive, Describe and demonstrate the proper application of the General Traumatic Arrest Protocol – Adult and Pediatric As evaluated by the facilitator during case presentations, skill stations, oral scenarios, and a written evaluation.

Blunt Trauma Mechanism of Injury MVC Sports Falls Crush injuries

Blunt Trauma Defib pads – analyze/interpret 1. Shockable, or Heart Rate > 0 – no TOR! 2. Heart Rate = 0 (non-shockable)

Penetrating Trauma Mechanism of Injury Gunshot Stabbing Broken bones

Penetrating Trauma Monitoring Electrodes only! 1. Heart Rate = 0 – patch! 1. Heart Rate > 0 AND ER > 20 min – patch! 2. Heart Rate > 0, AND ER < 20 min – no TOR!

TOR – Key Points! VSA Does not include Drowning Electrocution Hanging Isolated Burn Injury Patient 16 years of age or older Obvious Death?

What if it’s NOT a TOR? Does not meet TOR Directives OR BHP determines not to give TOR on patch

What if it’s NOT a TOR? Case Study: You arrive on scene to find a 30 year old male who is pinned under his tractor in 18” of water. You are able to determine he has no radial pulse, but you are not able to assess anything else. There is a 2 hour delay until a crane can remove the tractor. What do you do?

What if it’s NOT a TOR? Case Study You arrive on scene to find a 42 year old female impaled on a fence post. The patient was attempting to jump the fence when she became impaled in the femur. She is VSA with HR on the monitor of 50 bpm. Fire/Rescue state they cannot remove the patient without amputation. Closest ED is 5 min away.

Questions ? Contact SWORBHP

References Emergency Health Services Branch. (2007). Ministry of Health and Long Term Care BLS Basic Life Support Patient Care Standards, Version 2.0 Gervin AS., & Fischer RP. (1982). The importance of prompt transport in salvage of patients with penetrating heart wounds, Journal of Trauma, 22(6), Hopson LR., Hirsh, E., Delgado, J., Domeier RM., McSwain, NE., & Krohmer J. (2003). Guidelines for Withholding or Termination of Resuscitation in Prehospital Traumatic Cardiopulmonary Arrest, Prehospital Emergency Care, 7(1), p Leading Causes of Death, Canada, 2005, Males and Females Combined. (2005). Public Health Agency of Canada. Retrieved from

References Macpherson, AR., & Schull, MJ. (2007). Penetrating Trauma in Ontario Emergency Departments: A Population Based Study. Canadian Journal of Emergency Medicine, 9(1), Prentice D, Ahrens T. (1994). Pulmonary Complications of Trauma. Critical Care Nursing, 17 (2), 24–33 Salomone, J., Mercer, S., Chaplea, W., & Chapman, G. (2003). PHTLS Basic and Advanced Prehospital Trauma Life Support, St. Louis, Missouri: Elsevier Sasser, SM., et al. (2009). Centers for Disease Control and Prevention Guidelines for Field Triage of Injured Patients, Morbidity and Mortality Weekly Report MMWR Recommendations of the National Expert Panel on Field Triage, 58(1) Tien, HC., Spencer, F., Tremblay, LN., Rizoli, SB., & Brenneman, FE. (2007) Preventable Deaths from Hemorrhage at a Level 1 Canadian Trauma Centre. Journal of Trauma, 62(1),