Lesson 10 Summation Putting It All Together

Key Points (1 of 4) Safety of providers and patients –Number one priority Prearrival preparedness and scene assessment –Assessment begins before arriving at the scene Sufficient resources? –How many patients are involved? – Are there special scene needs?

Key Points (2 of 4) Access to patient General impression –History and mechanism of injury (kinematics) Identify immediate life threats and manage them –Primary assessment Transport and destination decisions

Key Points (3 of 4) Physically immobilize the patient as needed –Manually, then mechanically Patient extrication Assess and treat identified injuries and resulting conditions –Principles versus preferences Transportation and destination Communication and documentation

Key Points (4 of 4) Principle is what needs to be done for a patient based upon the assessment. Preference is how the principle is accomplished. –This will change depending on the: Situation at the scene Severity of the patient Knowledge and skills of the prehospital care provider Resources available

Identify and Manage Immediate Life Threats (1 of 5) Airway and breathing –Manually stabilize cervical spine as indicated –Suction as needed –Provide supplemental oxygen early –Support ventilations as necessary

Identify and Manage Immediate Life Threats (2 of 5) Airway and breathing (cont’d) –Use simple interventions before complex Example: Bag-mask device before intubation –Ventilate before and between intubation attempts –Maintain a proper rate of ventilation

Identify and Manage Immediate Life Threats (3 of 5) Circulation –Control obvious bleeding Conserve red blood cells Immobilize major fractures –Maintain body temperature

Identify and Manage Immediate Life Threats (4 of 5) Circulation (cont’d) –IVs can be started while en route –Provide no more fluid than necessary Avoid over-resuscitation that can lead to increased blood loss

Identify and Manage Immediate Life Threats (5 of 5) Disability –Maintain manual cervical stabilization until immobilization is complete –Calculate GCS score –Reassess for changes in the patient’s condition over time

Transportation and Destination (1 of 2) Patient handling –Identify patients requiring rapid extrication –Maintain manual stabilization while performing extrication –Recognize the limitations of immobilization devices –Maintain a team approach

Transportation –Transport to appropriate destination without delay –Utilize appropriate transport method and mode Transportation and Destination (2 of 2)

Communication and Documentation Communication –Provide clear, concise, accurate, timely, and complete communication with the receiving facility Documentation –Complete documentation is important for continued care, research, and accountability

Potential Pitfalls (1 of 2) Ignoring or failing to recognize scene hazards Focusing on distracting, non-life-threatening injuries Performing secondary assessment before life-threatening conditions have been assessed and managed Not performing a secondary assessment when indicated

Potential Pitfalls (2 of 2) Missing life-threatening conditions by not exposing and assessing the patient Not maintaining body temperature Prolonged scene times Inappropriate selection of destination

Golden Principles (1 of 7) Ensure the safety of the prehospital care providers and the patient Assess the scene situation to determine the need for additional resources

Golden Principles (2 of 7) Recognize the kinematics that produced the injuries Use the primary assessment to identify life-threatening conditions Courtesy of Mark Woolcock

Golden Principles (3 of 7) Provide appropriate airway management while maintaining cervical spine stabilization as indicated Support ventilation and deliver oxygen to maintain an SpO 2 greater than 95%

Golden Principles (4 of 7) Control any significant external hemorrhage Provide basic shock therapy, including appropriately splinting musculoskeletal injuries and restoring and maintaining normal body temperature

Golden Principles (5 of 7) Maintain manual spinal stabilization until the patient is immobilized For critically injured trauma patients, initiate transport to the closest appropriate facility as soon as possible after EMS arrival on scene Courtesy of Rick Brady

Golden Principles (6 of 7) Initiate warmed intravenous fluid replacement en route to the receiving facility Ascertain the patient’s medical history and perform a secondary assessment when life-threatening problems have been satisfactorily managed or have been ruled out Provide adequate pain relief

Golden Principles (7 of 7) Provide thorough and accurate communication regarding the patient and the circumstances of the injury to the receiving facility Above all, do no further harm

“Our patients did not choose us. We chose them.” “We have accepted this responsibility... we must give to our patients the very best care that we can.” “We must be ready to treat our patients by learning from our experiences and the science provided by prehospital research.” Norman E. McSwain, MD Medical Director, PHTLS Courtesy Norman McSwain, MD, FACS, NREMT-P

Questions?