1. Paramedic Care: Principles & Practice Volume 4 Trauma Emergencies
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ

2. Chapter 1 Trauma and Trauma Systems
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ

3. Topics Trauma Trauma as a Disease The Trauma Care System
Trauma Center Designation
Your Role as a Paramedic
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ

4. Trauma
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ

5. Trauma
Trauma is a physical injury or wound caused by external force or violence.
Leading killer of persons under 44 in the United States.
150,000 deaths annually
Most expensive medical problem in terms of lost wages, initial care, rehabilitation, and lifelong maintenance.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ

6. Trauma Trauma is typically divided into two major categories:
Penetrating
Injury caused by an object breaking the skin and entering the body
Blunt
Injury caused by the collision of an object with the body in which the object does not enter the body
Serious/life-threatening problems occur in less than 10% of all trauma patients.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ

7. Trauma
During your assessment it is essential that you determine the difference between a trauma patient with serious, life-threatening conditions and one who is less seriously injured.
The use of trauma triage criteria will aid you in making this determination.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ

8. Trauma as a Disease
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ

9. Trauma as a Disease Highway Safety Act of 1966
Led to development of EMS
Trauma was categorized as a disease
Trauma can often be prevented
The public health model
Surveillance, risk analysis, intervention development, implementation, and evaluation
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ

10. Surveillance
The collection of data to identify the existence, significance, and characteristics of a disease or disease process
Epidemiology
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ

11. Epidemiology
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ

12. Risk Analysis
Risk analysis examines the various factors that impact the development, course, and consequences of a disease.
Haddon Matrix
A three-by-three matrix that describes nine elements
Pre-event elements
Event elements
Post-event elements
Characteristics of the host
The agent
The environment
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ

13. Intervention Development
Creates or modifies programs to reduce both the incidence and the seriousness of trauma
Examples
Safer highway design
Autos with better braking systems, crumple zones, and passive restraint systems
Programs that encourage drivers to use their seatbelts, to not drink and drive, and to drive defensively
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ

14. Implementation Act of placing an intervention into practice Includes:
Enforcing traffic laws
Reducing speed limits in hazardous areas
Rebuilding highways to be safer
Building safer autos
Encouraging changes in driver behavior
Safety education
Continuing to improve our EMS system
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ

15. Evaluation Accomplished by repeating the processes of surveillance
To identify the benefit or ineffectiveness of an intervention or program
We must continue to search out risk factors, develop and implement interventions, and evaluate our systems’ performance
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ

16. The Trauma Care System
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ

17. The Trauma Care System Integration of Reduces Proper Care EMS
Hospital care
Reduces
Cost
Time to surgery
Mortality
Proper Care
Immediate surgical intervention to repair hemorrhage sites
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ

18. Trauma Center Designation
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ

19. Trauma Center Designation
The trauma system is predicated on the principle that serious trauma is a surgical disease.
Life-threatening injuries account for less than 10 percent of all trauma patients.
Surgical care for trauma patients can drastically reduce trauma mortality and morbidity.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ

20. Trauma Center Designation
The current model for a trauma system includes three levels of trauma center
Level I
Level II
Level III
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ

21. Trauma Center Designation
Level I
Regional Trauma Center
All types of surgical and medical subspecialty
Research and teaching commitment
Level II
Area Trauma Center
Majority of surgical and medical subspecialties available 24/7
Level III
Community Trauma Center
Specialized ED with the majority of surgical and medical subspecialties available 24/7 (on call)
Refer to the American College of Surgeons “Gold Book” for exact designations and criteria.
Level III – The ACS requires that surgical specialists be available to be called in within one hour from trauma team activation.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ

22. Trauma Center Designation
In some remote areas, there is provision for an additional level of trauma patient destination.
Level IV
Seriously injured trauma patients may be taken for stabilization and care before transport.
The design of a trauma system should be flexible in order to meet the needs of the region it serves.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ

23. Trauma Center Designation
Specialty Centers
Neurocenters
Burn Centers
Pediatric Trauma
Hyperbaric Medicine
Microsurgery
Neurocenters – Spinal surgeon
Burn Centers – Plastic surgery available
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ

24. Your Role as a Paramedic
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ

25. Your Role as a Paramedic
Trauma Triage Criteria
START
Nearest appropriate facility
Mechanism of Injury Analysis (MOI)
Processes and forces that cause trauma
Consider inertial forces
Index of Suspicion (IOS)
Anticipation of injury to a body region, organ, or structure based on MOI
Shock and head injury
Frequent reassessment and trending
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ

26. Your Role as a Paramedic
The Golden Period
BEST survivability from incident to surgery is 1 hour
Platinum 10 Minutes
Scene time limited to 10 minutes
Air Transport
Speed vs. need
Type of patients transported
© Bell Helicopter Textron, Inc.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ

27. Your Role as a Paramedic
The Decision to Transport
The trauma triage criteria are designed to help you with transport decisions.
These criteria are designed for the “over-triage” of trauma patients.
When applying trauma triage criteria, it is best to err on the side of precaution.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ

28. Your Role as a Paramedic
Injury Prevention
Bicycle safety programs
Firearm safety
Boat safety
Child safety seat classes and checking
Data and Trauma Registry
Data retrieval system for trauma patient information
© Austin County, Texas EMS
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ

29. Your Role as a Paramedic
Click here to view a video on trauma.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ

30. Your Role as a Paramedic
Quality Improvement
QI or QM
Examine the system performance and attempt to improve and provide better patient care
Evaluate calls to determine if standard of care was met
Accurate and complete documentation
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ

31. Summary Trauma Trauma as a Disease The Trauma Care System
Trauma Center Designation
Your Role as a Paramedic
Prevalence and significance of trauma.
Components of trauma system.
Characteristics of community, area, and regional trauma centers.
Trauma triage criteria.
Golden hour of care.
Value of air medical service in trauma patient care.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ