1. Trauma Overview: The Trauma Patient and the Trauma System
Chapter 27

2. Objectives Discuss Kinetics of Trauma Discuss Mechanism of Injury
Discuss the Multi-system Trauma Patient
Discuss The Golden Period
Discuss the Trauma System
Discuss Special Considerations in Trauma Care

3. The Kinetics of Trauma – Mass and Velocity
Mechanism of Injury (MOI)- How a person was injured
Kinetics of Trauma – Science of analyzing mechanisms of injury
Kinetic Energy – Energy contained in a moving body
Directly proportional to mass
Directly proportional to the square of velocity
During scene size-up, get the best estimate of the speed of the vehicle or vehicles at the time of the collision
Kinetic energy of two moving bodies that collide will be combined

4. Acceleration and Deceleration
The motion of an object will not change unless force acts upon it
Acceleration – An increase in speed
Deceleration – A decrease in speed
Faster acceleration or deceleration results in greater force on the human body

5. Kinetics of Trauma Energy Changes Form and Direction
If energy is transmitted to a body in a straight line, injure may not occur
If energy is interrupted, injury can occur
May be interrupted by a curve of bone
by an organ between a hard surface
by tissue pulled against a fixed point

6. Kinetics of Trauma Impacts
Types of Impacts
Vehicle collision – Vehicle suddenly stops and gets bent out of shape
Body collision – Patient comes to a quick stop on some part or parts of the inside
Organ collision – Internal organs come to a quick stop
Investigating kinetics
Person in or on a moving vehicle gets thrown has a much greater chance of injury than one who is restrained or remains within the vehicle
The faster a vehicle is travelling, the greater the kinetic energey, greater the force, and greater the potential for injury

7. Mechanism of Injury Vehicle Collisions
Situations that should have a high index of suspicion:
Death of another occupant
Unresponsive patient or patient with an altered mental status
Intrusion of greater than 12” for the occupant side or greater than 18” anywhere on the vehicle
Ejection

8. Mechanism of Injury Vehicle Collisions
Classification of collisions
Frontal Impact
Rear-end impact
Lateral impact
Rotational/rollover
Vehicle-pedestrian
Restraints
Considerations for infants and children
Motorcycle collisions

9. Frontal Impact Frontal impact
Abdomen, Chest, Face, Head, and neck
In a frontal collision, the occupant continues to move forward at the same speed the vehicle was moving.
The up-and-over pathway causes impact to the head, neck, chest, and abdomen.

10. Frontal Impact
The down-and-under pathway causes impact to the knees, femurs, hips, acetabulum, and spine.
Examples of mechanisms of injury associated with frontal impact.

11. Frontal Impact
A deformed steering wheel indicates possible chest or abdominal injury. (© Jeff Forster)
The “paper bag” syndrome results from compression of the chest against the steering column.
Impact marks or cracking to the windshield indicates a possible head injury

12. Rear-end impact Injuries to suspect: Head or Neck
(a) In a rear impact with an unrestrained occupant, initial movement is backward, causing potential neck injury
(b) The occupant then moves forward, causing impact to the head and chest

13. Lateral impact Injuries to suspect:
Lateral impact causes impact to the head, shoulder, lateral chest, lateral abdomen, lateral pelvis, and femur.

14. Rotational or Rollover crash
In a rollover of an unrestrained occupant, impact to the body is difficult to predict and commonly results in multiple system injury
Ejection is common
Crushing
injuries

15. Vehicle-pedestrian collision
A child about to be hit by a vehicle generally turns toward the vehicle. (© Mark C. Ide)
Consider the speed of the vehicle
What part of the body was hit
How far the body was thrown
The surface the body landed on
Body part that first struck the ground

16. Restraints Airbags or Seatbelts
Seat belt injuries to (a) the upper chest. (Photo: © Edward T. Dickinson, MD)
Seat belt injuries to (b) the abdomen. (Photo: © Edward T. Dickinson, MD)

17. Considerations for infants and children
Any parts of the body that are not restrained continue to move forward
Children should always be restrained in the back seat to avoid injury from air bag deployment

18. Motorcycle collisions
Head-on impact
Angular impact
Ejection
“Laying down the bike”
Motorcycle collisions can result in multisystem trauma from multiple impacts to the rider. (© CW McKean/ Syracuse Newspapers/The Image Works)
Soft tissue injury to the forehead and face
All-terrain vehicles (ATVs) can cause multiple injuries from the combination of speed and instability.

19. Mechanism of Injury Falls
Severity factors
Distance
Surface
Body part impacted first
Objects that interrupt the fall

20. Mechanism of Injury Falls
Feet-first falls
Fractures of the heels and fractures/dislocations of the ankles are common
Spine will absorb the force at every curve of the lumbar
Falls more than 20 ‘ the internal organs are likely to be injured from deceleration forces
A fracture of the wrist is common
If the body is thrown backward, the most common injuries are head, back, and pelvis

21. Mechanism of Injury Falls
Head-first falls
Injury begins with the arms and extends up to the shoulders
The head may be forcibly hyperextended, hyperflexed, or compressed
Extensive damage to the cervical spine can occur
Chest, lower spine, and pelvis injuries are common

22. Mechanism of Injury Penetrating injuries
The severity of injury caused by penetrating trauma is related to the velocity of the penetrating object.
Low-velocity injuries
An object impaled exerts damage to the immediate area of the impact and its underlying structures
The length of the object used provides valuable clues about the injury

23. Mechanism of Injury Penetrating injuries
Medium-and-high velocity injuries
Trajectory - the path or motion of a projectile during its travel
Dissipation of energy is the way energy is transferred to the human body from the force acting upon it;
Drag
Profile
Cavitation
Fragmentation

24. Fatal wounds – 90% involves the head, thorax, and abdomen
Wounds also occur to the neck and extremities
Head;
Projectile entering the skull causes brain tissue to be compressed
Projectile entering the face threatens the airway
Chest
Pneumothorax is common
Outer covering of the heart may be able to seal itself from low-velocity, high-velocity causes significant wounds
Suspect both thorax and abdominal injuries if entrance wound between nipple and waist
Abdomen
Often secondarily injured when chest involved
Majority are not rapidly fatal but needs surgery
Extremities
Bone injury becomes bony fragments turning into secondary missiles
Muscle expands, resulting in capillary tears and swelling
Vessels can be severed, ripped, buckled, and/or obstructed
Gunshot wounds
A wound resulting from close-range shotgun blast. Note the tattooing of the skin from the gunpowder.

25. Mechanism of Injuries Blast injuries
Primary phase injuries are due to the pressure wave of the blast
Secondary phase are due to flying debris propelled by the force of the blast
Tertiary phase injuries occur when the patient is thrown away from the source of the blast

26. Blast injuries can cause injury with the initial blast, when the patient is struck by debris, or by the patient being thrown from the site of the blast.
Blast injuries can cause injury with the initial blast, when the patient is struck by debris, or by the patient being thrown from the site of the blast

27. Blast injuries can cause injury with the initial blast, when the patient is struck by debris, or by the patient being thrown from the site of the blast.
Blast injuries can cause injury with the initial blast, when the patient is struck by debris, or by the patient being thrown from the site of the blast

28. The Multisystem Trauma Patient
Has multiple injuries or involvement of more than one body system
Multiple organ injuries also are considered to by multisystem trauma
Multisystem trauma carries a high incidence of morbidity and mortality

29. The Golden Period
Relates to the time during which a patient needs intervention in order to survive
Length of time indicated by the “golden period” depends on the patient injury
EMT’s must assess, treat, and transport the injured patient as quickly as possible

30. The Golden Period
The “platinum ten minutes” is the maximum time the EMS team should devote to on-scene activities with patient assessment, emergency care for life threats, and preparation for transport
If a patient is not severely injured, more time can be devoted to completing normal on-scene assessment and emergency care before transport

31. The Trauma System
Designed to provide immediate surgical intervention for patients with internal trauma
Requires significant resources and is expensive to maintain
Common designation of trauma centers;
Level 1 – Regional Trauma Center
Level II – Area Trauma Center
Level III – Community Trauma Center
Level IV – Trauma Facility
Crucial that EMS personnel triage patients accurately for transport to the appropriate trauma center

32. Special Considerations in Trauma Care
Principles of out-of-hospital trauma care;
Ensure at all times the safety of EMS personnel, patients, and bystanders
Quickly determine need for additional resources
Determine the MOI and kinematics involved
Provide a primary assessment
Establish and maintain spinal stabilization
Establish and maintain airway
Establish and maintain adequate oxygenation
Provide ventilation

33. Special Considerations in Trauma Care
Principles of out-of-hospital trauma care;
Control external hemorrhage with direct pressure
Treat for shock
Consider application of PASG (Whatcom Co Protocol Page 17)
Maintain manual spinal stabilization until patient is immobilized on backboard
Transport critically injured or multisystem trauma patients with 10 minutes
Obtain a history from patient, relatives, bystanders
Perform secondary assessment

34. Special Considerations in Trauma Care
Your personal safety is of utmost importance
Airway management, adequate ventilation, and oxygenation are key elements
Stop significant bleeding
Assessment of trauma patient is conducted in a sequence that promotes a rapid systemic approach
Rapid transport is essential
A backboard can secure suspected fractures in an unstable patient who requires rapid transport
Do not develop tunnel vision and become focused on dramatic injuries or dramatic patients

36. Questions ????