Trauma Protocols

Bites and Envenomation’s Protocol 5-01

Burns: Chemical and Electrical Protocol 5-02

Burns: Thermal Protocol 5-03

Crush Syndrome Protocol 5-04

Drowning Protocol 5-05

Extremity Trauma Protocol 5-06

Head Trauma Protocol 5-07

Hyperthermia Protocol 5-08

Hypothermia Protocol 5-09

Multi-System Trauma Protocol 5-10

Sexual Assault Protocol 5-11

Traumatic Arrest Protocol 5-12

2/2015 TRINITY EMS SYSTEM PREHOSPITAL GUIDELINES

Approved by EMS Medical Director 2012 BITES AND ENVENOMATIONS TRAUMA PROTOCOL # 5 - 01 HISTORY SIGNS AND SYMPTOMS DIFFERENTIAL ü Type of bite/sting ü Rash, skin break, wound ü Animal bite ü Description of creature or photograph for ü Pain, soft tissue swelling, redness ü Human bite identification ü Blood oozing from the bite wound ü Snake bite (poisonous) ü Time, location, size of bite/sting ü Evidence of infection ü Spider bite (poisonous) ü Previous reaction to bite/sting ü Shortness of breath, wheezing ü Insect sting/bite (bee, wasp, ant, tick) ü Domestic v. wild ü Allergic reaction, hives, itching ü Infection risk ü Tetanus and Rabies risk ü Hypotension or shock ü Rabies risk ü Immunocompromised patient ü Tetanus risk TRAUMA PROTOCOL LEGEND

F FIRST RESPONDER B EMT-BASIC Universal Patient Care Protocol I EMT-INTERMEDIATE P PARAMEDIC

M MEDICAL CONTROL # 5 -

Position patient supine 01 F Immobilize area or limb F Apply ice/cold pack if appropriate

Animal Bite: Document County of Occurrence and Contact with Law Enforcement or Animal Control

Refer to appropriate protocols if necessary: Pain Control Allergic Reaction

Contact Medical Control and Notify M M Destination

PEARLS ü Recommended Exam: Mental Status, Skin, Extremities (Location of Injury), and a complete Neck, Lung, Heart, Abdomen, Back, and Neuro exam if system effects are noted ü Human bites have a higher infection rate than animal bites due to normal mouth bacteria ü Carnivore bites are much more likely to become infected and all have risk of Rabies exposure ü Cat bites may progress to infection rapidly due to specific bacteria (Pasteurella multicoda) ü Poisonous snakes in the area are rare, but are of the pit viper family: Timber rattlesnakes and water moccasins. If no pain or swelling, envenomation is unlikely ü Brown Recluse spider bites are minimally painful to painless. Little reaction is noted initially, but tissue necrosis at the site of the bite develops over the next few days (brown spider with fiddle shape on back) ü Evidence of infection: swelling, redness, drainage, fever, red streaks proximal to wound ü Immunocompromised patients are at increased risk for infection: diabetes, chemotherapy, transplant patients ü Consider contacting the Illinois Poison Control Center for guidance: 1 800 222 1222

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Approved by EMS Medical Director 2012 BURNS: CHEMICAL & ELECTRICAL TRAUMA PROTOCOL # 5 - 02

HISTORY SIGNS AND SYMPTOMS DIFFERENTIAL ü Type of exposure (heat, gas, chemical) ü Burns, pain, swelling ü Superficial (1st Degree) – red and painful ü Inhalation injury ü Dizziness ü Partial Thickness (2nd Degree) – blistering ü Past medical history and medications ü Loss of consciousness ü Full Thickness (3rd Degree) – painless/charred or leathery skin ü Other trauma ü Hypotension, shock ü Thermal ü Loss of consciousness ü Airway compromise/distress ü Chemical ü Tetanus/Immunization status ü Singed facial hair or nasal hair ü Electrical ü Hoarseness/wheezing ü Radiation

Universal Patient Care Protocol LEGEND F FIRST RESPONDER TRAUMA PROTOCOL

Rule of 9's B EMT-BASIC I Cardiac Monitor I I EMT-INTERMEDIATE

P PARAMEDIC

M MEDICAL CONTROL Eye involvement? Continuous saline flush in affected eye. Flush with water or Normal Saline for 10-15 minutes Remove rings, bracelets, and other constricting items. # 5 - Remove clothing or exposed area.

Identify entry and exit sites. Apply sterile dressings. 02

Pain Control Protocol I I IV meds only for Burn Patients IV Access Protocol I I Normal Saline Bolus

Chemical and Electrical Burn patients must be triaged using the guidelines below and their care must conclude in the Thermal Burn Protocol

CRITICAL SERIOUS MINOR (RED) (YELLOW) (GREEN)

>15% TBSA 2nd/3rd Degree 5-15% TBSA 2nd/3rd Degree <5% TBSA 2nd/3rd Degree Burn Burn Burn No inhalation injury Burns with multiple trauma Suspected inhalation injury Not intubated Burns with definitive airway or requiring intubation for Normotensive compromise airway stabilization GCS>14 Hypotension or GCS<14

PEARLS – CHEMICAL PEARLS – ELECTRICAL ü Refer to Decontamination Standard Procedure ü Do not contact the patient until you are certain the source of electric shock ü Certainly 0.9% NaCl or Sterile Water is preferred; however, if it is not readily has been disconnected. available, do not delay, use tap water for flushing the affected area or other ü Attempt to locate contact points (entry wound where the AC source contacted immediate water sources. Flush the area as soon as possible with the cleanest the patient, an exit at the ground point) both sites will generally be full readily available water or saline solution using copious amounts of fluids thickness. ü Cardiac monitor, anticipate ventricular or atrial irregularity, to include V-tach, V-fib, heart blocks, etc. ü Attempt to identify the nature of the electrical source (AC v. DC), the amount of voltage, and the amperage the patient may have been exposed to during the electrical shock.

TRINITY EMS SYSTEM PREHOSPITAL GUIDELINES 2012 2/2015 TRINITY EMS SYSTEM PREHOSPITAL GUIDELINES

Approved by EMS Medical Director 2012 BURNS: THERMAL TRAUMA PROTOCOL # 5 - 03

HISTORY SIGNS AND SYMPTOMS DIFFERENTIAL ü Type of exposure (heat, gas, chemical) ü Burns, pain, swelling ü Superficial (1st Degree) – red and painful ü Inhalation injury ü Dizziness ü Partial Thickness (2nd Degree) – blistering ü Time of injury ü Loss of consciousness ü Full Thickness (3rd Degree) – painless/charred ü Past medical history ü Hypotension/shock or leathery skin ü Medications ü Airway compromise/distress ü Thermal ü Other trauma ü Singed facial hair or nasal hair ü Chemical ü Loss of consciousness ü Hoarseness/wheezing ü Electrical ü Tetanus/Immunization status ü Radiation

LEGEND Universal Patient Care Protocol F FIRST RESPONDER TRAUMA PROTOCOL B EMT-BASIC I EMT-INTERMEDIATE P PARAMEDIC M MEDICAL CONTROL CRITICAL SERIOUS MINOR (RED) (YELLOW) (GREEN) # nd rd nd rd nd rd >15% TBSA 2 /3 Degree 5-15% TBSA 2 /3 Degree <5% TBSA 2 /3 Degree 5 -

Burn Burn Burn Rule of 9's 03 Burns with multiple trauma Suspected inhalation injury No inhalation injury Burns with definitive airway or requiring intubation for Not intubated compromise airway stabilization Normotensive Hypotension or GCS<14 GCS>14

Remove rings, bracelets, and other Cool down the wound with Normal constricting items Saline Airway Protocol Cover burn with dry, sterile sheet or (Adult or Peds) dressings Cover burn with dry, sterile sheet or dressings Normal Saline Infuse total of 0.25 x Normal Saline I kg body weight x I 2 large bore IVs %TBSA per hour for I Infuse total of 0.25 x I first 8 hours kg body weight x %TBSA per hour for first 8 hours Pain Control Protocol (Adult or Peds) CRITICAL OR SERIOUS BURNS ü > 5 – 15% TBSA; 2nd or 3rd degree burns, or rd ü 3 degree burns > 5% TBSA for any age group, or Contact Medical Control ü Circumferential burns of extremities or M M ü Suspicion of abuse or neglect, or and Notify Destination ü Inhalation injury, or ü Chemical burns, or ü Burns of face, hands, perineum, or feet, or ü Any burn requiring hospitalization

PEARLS ü Burn patients are trauma patients! Evaluate for multisystem trauma ü Assure whatever has caused the burn is no longer contacting the injury (STOP THE BURNING PROCESS) ü Recommended Exam: Mental Status, HEENT, Neck, Heart, Lungs, Abdomen, Extremities, Back and Neuro ü Early intubation is required when the patient experiences significant inhalation injuries ü Potential CO exposure should be treated with 100% oxygen ü Circumferential burns to extremities are dangerous due to potential vascular compromise secondary to soft tissue swelling ü Burn patients are prone to hypothermia – never apply ice or cool burns; must maintain normal body temperature ü Evaluate the possibility of child abuse with children and burn injuries

TRINITY EMS SYSTEM PREHOSPITAL GUIDELINES 2012 2/2015 TRINITY EMS SYSTEM PREHOSPITAL GUIDELINES

Approved by EMS Medical Director 2012 CRUSH SYNDROME TRAUMA PROTOCOL # 5 - 04 HISTORY SIGNS AND SYMPTOMS DIFFERENTIAL ü Agricultural injury ü Hypothermia ü Abrasion/Contusion ü Industrial accident ü Pain, swelling ü Laceration ü Construction ü Altered sensation/motor function ü Sprain ü Diminished pulses/capillary refill ü Dislocation/Fracture ü Compartment Syndrome

LEGEND Universal Patient Care Protocol

F FIRST RESPONDER TRAUMA PROTOCOL B EMT-BASIC Consider the 5 Ps: I EMT-INTERMEDIATE Pain Treat for Hypothermia if Pallor P PARAMEDIC indicated Paresthesia Poikilothermia M MEDICAL CONTROL Pulselessness

Apply tourniquets to # affected extremity/ 5 -

extremities 04 Ensure airway prophylactically if F F Oxygen 15L NRB appropriate CONTACT MEDICAL CONTROL UPON F Vital Signs F ARRIVAL TO SCENE ALS MUST BE CALLED FOR CRUSH INJURY. IF POSSIBLE, ALS SHOULD BE PRESENT B Albuterol 2.5 mg Nebulized B BEFORE RELEASE OF CRUSH INJURY

I Normal Saline Bolus I Maintain systolic BP > 100

Sodium Bicarbonate P 50 mEq in 1L NS P Administer entire 1L Normal Saline

B 12 Lead EKG if available B

EKG Changes No EKG Changes

Calcium Chloride RAPID TRANSPORT AND P P M M 1 gram IV with 20 ml flush CONTACT MEDICAL CONTROL

PEARLS ü EKG changes of hyperkalemia include peaked T waves, loss of P waves, wide QRS ü Crush injuries lead to rapid release of potassium from cells. Overload of potassium leads to cardiac dysrhythmias ü Patients who have been trapped can appear hemodynamically stable until released. After release, patient can become unstable very quickly. Do not delay life saving measures for ALS if immediate threat to life exists ü ALS should be on scene prior to release of any crush injury ü Monitor lung sounds, patient is at risk for pulmonary edema

TRINITY EMS SYSTEM PREHOSPITAL GUIDELINES 2012 2/2015 TRINITY EMS SYSTEM PREHOSPITAL GUIDELINES

Approved by EMS Medical Director 2012 DROWNING TRAUMA PROTOCOL # 5 - 05 HISTORY SIGNS AND SYMPTOMS DIFFERENTIAL ü Submersion in water regardless of depth ü Unresponsive ü Trauma ü Possible trauma to cervical spine ü Mental status changes ü Pre-existing medical problem ü Possible history of trauma, e.g., diving ü Decreased or absent vital signs ü Pressure injury (diving) board ü Vomiting Barotrauma ü Duration of immersion ü Coughing Decompression sickness ü Temperature of water or possibility of ü Apnea ü Post-immersion syndrome hypothermia ü Stridor ü Wheezing ü Rales TRAUMA PROTOCOL

Universal Patient Care Protocol LEGEND F FIRST RESPONDER

B EMT-BASIC

Spinal Immobilization Procedure I EMT-INTERMEDIATE #

P PARAMEDIC 5 -

B Pulse Oximetry B 05 M MEDICAL CONTROL B 12 Lead EKG if available B

I Cardiac Monitor I

I IV Access Protocol I

Consider Albuterol 2.5 mg I Nebulized I for respiratory distress CPAP P Consider for respiratory P distress

Monitor and reassess

Appropriate Protocol Based on symptoms

Contact Medical Control and Notify M M Destination

PEARLS ü Recommended Exam: Trauma Survey, Head, Neck, Chest, Abdomen, Pelvis, Back, Extremities ü Have a high index of suspicion for possible spinal injuries ü There is no time limit on cold water drownings. Resuscitate all cold water drownings. Patients have increased chance of survival ü Some patients may develop delayed respiratory distress ü All victims should be transported for evaluation due to potential for worsening over the next several hours ü Drowning is a leading cause of death among would-be rescuers ü All appropriately trained and certified rescuers to remove victims from areas of danger

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Approved by EMS Medical Director 2012 EXTREMITY TRAUMA TRAUMA PROTOCOL # 5 - 06 HISTORY SIGNS AND SYMPTOMS DIFFERENTIAL ü Type of injury ü Pain, swelling ü Abrasion ü Mechanism: crush/penetrating/ ü Deformity ü Contusion amputation ü Altered sensation/motor function ü Laceration ü Time of injury ü Diminished pulse/capillary refill ü Sprain ü Open vs. closed wound/fracture ü Decreased extremity temperature ü Dislocation ü Wound contamination ü Fracture ü Medical history ü Amputation ü Medications TRAUMA PROTOCOL

LEGEND Universal Patient Care Protocol F FIRST RESPONDER

B EMT-BASIC

I EMT-INTERMEDIATE

Wound care # P PARAMEDIC 5 - F Control hemorrhage F with pressure 06 Splinting as required M MEDICAL CONTROL

If hemorrhage cannot be controlled F by direct pressure and is life-threatening, F consider Tourniquet Procedure

I IV Access Protocol I

Pain Control Protocol (Adults or Peds)

If amputation is clean, F wrap amputated part in sterile dressing soaked F in normal saline and place in air tight container. Place container on ice if available.

M Contact Medical Control and Notify Destination M

PEARLS ü Recommended Exam: Mental Status, Extremity, Neuro ü Peripheral neurovascular status is important ü In amputations, time is critical. Transport and notify medical control immediately, so that the appropriate destination can be determined ü Dislocations/fractures of hip, knee, or elbow have high incidence of vascular compromise ü Urgently transport any injury with vascular compromise ü Blood loss may be concealed or not apparent with extremity trauma ü Lacerations must be evaluated for repair within 6 hours of injury

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Approved by EMS Medical Director 2012 HEAD TRAUMA TRAUMA PROTOCOL # 5 - 07

HISTORY SIGNS AND SYMPTOMS DIFFERENTIAL ü Time of injury ü Pain, swelling, bleeding ü Skull fracture ü Mechanism (blunt v. penetrating) ü Altered mental status ü Brain injury (concussion, contusion, hemorrhage, or ü Loss of consciousness ü Unconsciousness laceration) ü Bleeding ü Respiratory distress/failure ü Epidural hematoma ü Past medical history ü Vomiting ü Subdural hematoma ü Medications ü Major traumatic mechanism of injury ü Subarachnoid bleed ü Evidence for multi-trauma ü Seizure ü Spinal injury ü Abuse

Universal Patient Care Protocol LEGEND

F FIRST RESPONDER TRAUMA PROTOCOL Adult Multiple Trauma Protocol NO Isolated Head Trauma? B EMT-BASIC YES I EMT-INTERMEDIATE

Spinal Immobilization Procedure P PARAMEDIC

M MEDICAL CONTROL I IV Access Protocol I # 5 -

07 Obtain GCS

GCS <8 If intubation, consider I Lidocaine 1 mg/kg and I NO Can patient cough or speak? Fentanyl 50-75 mcg IV Airway Protocol YES (Adult or Peds) ETCO2 BVM I Maintain between I F Basic airway maneuvers with F 35 - 45 Maintain pulse ox >90% REPEAT GCS >8 EVERY 5 MINUTES Seizure Protocol YES Seizure

NO

I D50 slow IVP I <60 B Blood Glucose B Glucagon 1mg IM I I if no IV available >60 Narcan I Consider I 2 mg IV/IO Monitor and reassess

Contact Medical Control and Notify M M Destination

PEARLS ü Recommended Exam: Mental Status, HEENT, Heart, Lungs, Abdomen, Extremities, Back, Neuro ü If GCS <12 consider air/rapid transport ü In the absence of capnography, hyperventilate the patient (adult: 20 breaths/minute; child: 30; infant: 35) ONLY if ongoing evidence of brain herniation (blown pupil, decorticate or decerebrate posturing, or bradycardia) ü Increased intracranial pressure (ICP) may cause hypertension and bradycardia (Cushing’s Response) ü Hypotension usually indicates injury or shock unrelated to the head injury and should be aggressively treated ü The most important item to monitor and document is a change in the level of consciousness ü Consider restraints if necessary for patient’s and/or personnel’s protection per the Restraint Procedure ü Limit IV fluids unless patient is hypotensive ü Concussions are periods of confusion or LOC associated with trauma which may have resolved by the time EMS arrives . Any prolonged confusion or mental status abnormality which does not return to normal within 15 minutes or any documented loss of consciousness should be evaluated by a physician ASAP ü In areas with short transport times, RSI/Drug-Assisted Intubation is not recommended for patients who are spontaneously breathing and who have oxygen saturations > 90% with supplemental oxygen TRINITY EMS SYSTEM PREHOSPITAL GUIDELINES 2012 2/2015 TRINITY EMS SYSTEM PREHOSPITAL GUIDELINES

Approved by EMS Medical Director 2012 HYPERTHERMIA TRAUMA PROTOCOL # 5 - 08 HISTORY SIGNS AND SYMPTOMS DIFFERENTIAL ü Age ü Altered mental status or ü Fever (infection) ü Exposure to increased temperatures and / unconsciousness ü Dehydration or humidity ü Hot, dry, or sweaty skin ü Medications ü Past medical history ü Hypotension or shock ü Hyperthyroidism (Storm) ü Medications ü Seizures ü Delirium Tremens (DT’s) ü Extreme exertion ü Nausea ü Heat cramps ü Time and length of exposure ü Heat exhaustion ü Poor PO intake ü Heat stroke ü Fatigue/muscle cramping ü CNS lesions or tumors TRAUMA PROTOCOL

Universal Patient Care Protocol LEGEND F FIRST RESPONDER

B EMT-BASIC Document patient temperature I EMT-INTERMEDIATE Remove clothing #

F F P PARAMEDIC 5 - Remove from heat source

M MEDICAL CONTROL 08 Apply room temperature water to skin and increase air flow around patient

I Cardiac Monitor I

B 12 Lead EKG if available B

IV Access Protocol I I Normal Saline Bolus (may repeat)

Monitor and reassess

Appropriate Protocol Based on Patient’s symptoms

Contact Medical Control and Notify M M Destination

PEARLS ü Recommended Exam: Mental Status, Skin, HEENT, Heart, Lungs, Neuro ü Extremes of age are more prone to heat emergencies ü Predisposed by use of: tricyclic antidepressants, phenothiazines, anticholinergic medications ü Cocaine, amphetamines, and salicylates may elevate body temperature ü Sweating generally disappears as body temperature rises above 104º F (40º C) ü Intense shivering may occur as patient is cooled ü Heat cramps consist of benign muscle cramping secondary to dehydration and is not associated with an elevated temperature ü Heat exhaustion consists of dehydration, salt depletion, dizziness, fever, mental status changes, headache, cramping, nausea, and vomiting. Vitals signs usually consist of tachycardia, hypotension, and an elevated temperature ü Heat stroke consists of dehydration, tachycardia, hypotension, temperature >104º F (40º C) and an altered mental status

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Approved by EMS Medical Director 2012 HYPOTHERMIA TRAUMA PROTOCOL # 5 - 09 HISTORY SIGNS AND SYMPTOMS DIFFERENTIAL ü Past medical history ü Cold, clammy ü Sepsis ü Medications ü Shivering ü Environmental exposure ü Exposure to environment even in normal temperatures ü Mental status changes ü Hypoglycemia ü Exposure to extreme cold ü Extremity pain or sensory ü CNS dysfunction ü Extremes of age abnormality Stroke ü Drug use: alcohol, barbiturates ü Bradycardia Head injury ü Infections/Sepsis ü Hypotension or shock Spinal cord injury ü Length of exposure/Wetness TRAUMA PROTOCOL Universal Patient Care Protocol LEGEND F FIRST RESPONDER

I Cardiac Monitor I B EMT-BASIC

I EMT-INTERMEDIATE F Temperature < 95º F (35º C) F P PARAMEDIC #

YES 5 - M MEDICAL CONTROL

Handle very gently 09 F Remove wet clothing F Hot packs and blankets B Blood glucose B

If glucose <60 I D50 IV/IO (Adult) I NO D25 IV/IO (Pediatric)

I Glucagon 1 mg IM (if no IV) I

I Consider Narcan 0.4 - 2 mg IV I

Appropriate Protocol based on patient’s symptoms

M Contact Medical Control and Notify Destination M

PEARLS ü Recommended Exam: Mental Status, Heart, Lungs, Abdomen, Extremities, Neuro ü NO PATIENT IS DEAD UNTIL WARM AND DEAD (core temperature >95º) ü Extremes of age are more susceptible to hypothermia ü With temperatures less than 86º F (30º C), ventricular fibrillation is common cause of death. Handling patients gently may help prevent this ü If the temperature cannot be measured, treat the patient based on suspected temperature ü Hypothermia may produce severe bradycardia so take at least 45 seconds to palpate a pulse ü Hot packs can be activated and placed armpit and groin area if available. Care should be taken not to place packs directly against patient’s skin ü Consider withholding CPR if patient has organized rhythm or other signs of life. Contact Medical Control ü Intubation can cause ventricular fibrillation; the most proficient person should perform this skill gently ü Do not hyperventilate the patient as this can cause ventricular fibrillation ü If the patient is below 86ºF (30ºC), then defibrillate 1 time if defibrillation is required. Normal defibrillation procedure may resume once patient reaches 86ºF (30ºC) ü Anti-arrhythmics may not work below 86ºF (30ºC), and if given, should be administered at reduced intervals. Contact Medical Control before administering ü Pacing should not be done below 86ºF (30ºC) TRINITY EMS SYSTEM PREHOSPITAL GUIDELINES 2012 2/2015 TRINITY EMS SYSTEM PREHOSPITAL GUIDELINES

Approved by EMS Medical Director 2014 MULTI-SYSTEM TRAUMA TRAUMA PROTOCOL # 5 - 10

HISTORY SIGNS AND SYMPTOMS DIFFERENTIAL (LIFE THREATENING) ü Time and mechanism of injury ü Pain, swelling ü Chest: Tension pneumothorax, Flail ü Damage to structure or vehicle ü Deformity, lesions, bleeding chest, Cardiac tamponade, Open chest ü Location in structure or vehicle ü Altered mental status or unconscious wound, Hemothorax ü Others dead or injured ü Hypotension or shock ü Spine Fractures/Spinal Cord Injury ü Speed and details of MVC ü Arrest ü Intra-abdominal bleeding ü Restraints and protective equipment ü Pelvis/femur fracture ü Past medical history ü Head injury (see Head Trauma) ü Medications ü Laryngeal fracture/ airway obstruction ü Hypothermia TRAUMA PROTOCOL

LEGEND Universal Patient Care Protocol F FIRST RESPONDER

B EMT-BASIC Spinal Immobilization Procedure I EMT-INTERMEDIATE

P PARAMEDIC # Airway Protocol 5 -

M MEDICAL CONTROL 10 F Vital signs including GCS F

ABNORMAL NORMAL

Rapid Transport to appropriate destination using F Complete assessment F Trauma Field Criteria Destination Protocol LIMIT SCENE TIME TO 10 MINUTES Splint suspected fractures PROVIDE EARLY NOTIFICATION F Consider pelvic binding F IV Access Protocol Control external hemorrhage I Normal Saline bolus I May repeat for hypotension Transport to appropriate destination using Trauma Field Criteria Destination Protocol Splint suspected fractures F Consider pelvic binding F Control external hemorrhage F Continually reassess F

Tension pneumothorax? Tranexamic Acid (TXA) P P P Consider P Chest decompression if at risk for significant hemorrhage Tranexamic Acid (TXA) P Consider P if at risk for significant hemorrhage Contact Medical Control and Head Injury Protocol M M Consider Notify Destination

PEARLS ü Recommended Exam: Mental Status, Skin, HEENT, Heart, Lung, Abdomen, Extremities, Back, Neuro ü Transport Destination is based on the EMS System Trauma Plan with EMS pre-arrival notification ü Geriatric patients should be evaluated with a high index of suspicion. Often occult injuries are more difficult to recognize ü Mechanism is the most reliable indicator of serious injury ü In prolonged extrications, serious multi-system trauma, or traumatic brain injury, consider air transport ü Early administration of TXA(less than 1 hour from injury) provides increased benefit, and must be given within 3 hours of injury ü Excessive rapid administration of the TXA 1 gram bolus may cause hypotension ü Scene times should not be delayed for procedures and should be performed en route when possible ü Rapid transport of the unstable trauma patient is the goal ü BVM is an acceptable method of managing the airway if pulse oximetry can be maintained >90%

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Approved by EMS Medical Director 2012 SEXUAL ASSAULT TRAUMA PROTOCOL # 5 - 11 HISTORY SIGNS AND SYMPTOMS DIFFERENTIAL ü Complaint of sexual assault ü Unable to recall events ü PTSD/Anxiety ü Drugs or alcohol – patient may not be able ü Physical signs may or may not be ü Multisystem Trauma to recall the assault or events preceding present on initial exam ü Sexually Transmitted Diseases the assault ü Emotional stress ü Flat affect

Universal Patient Care Protocol LEGEND TRAUMA PROTOCOL# 11 TRAUMA 5 - F FIRST RESPONDER

B EMT-BASIC

I EMT-INTERMEDIATE Scene Safety F F Notify Law Enforcement if not already done P PARAMEDIC

M MEDICAL CONTROL

Discourage patient from changing clothes, F showering, going to the bathroom, brushing F teeth, drinking fluids

F Do not examine the genital area unless F apparent injuries in need of treatment

B All linen used by patient in ambulance should be B left with ED staff

Contact Medical Control and Notify M M Destination

PEARLS ü Early notification to trauma center ensures timely notification of Sexual Assault Nurse Examiner ü Discouraging patient from changing clothes, showering, going to the bathroom, brushing teeth, or drinking fluids helps ensure the quality of evidence ü Collaborate with the police to determine what articles will be transported with the patient. Police may package evidence on scene or in the ED

TRINITY EMS SYSTEM PREHOSPITAL GUIDELINES 2012 2/2015 TRINITY EMS SYSTEM PREHOSPITAL GUIDELINES

Approved by EMS Medical Director 2012 TRAUMATIC ARREST TRAUMA PROTOCOL # 5 - 12 HISTORY SIGNS AND SYMPTOMS DIFFERENTIAL ü Patient who has suffered traumatic injury ü Evidence of penetrating trauma ü Medical condition preceding traumatic event as and is now pulseless ü Evidence of blunt trauma cause of arrest ü Tension pneumothorax ü Hypovolemic shock External hemorrhage Unstable pelvic fracture Displaced long bone fracture(s) Hemothorax Intra-abdominal hemorrhage

Retroperitoneal hemorrhage TRAUMA PROTOCOL

Universal Patient Care Protocol LEGEND F FIRST RESPONDER

B EMT-BASIC Patient with injury obviously incompatible with life in traumatic arrest? I EMT-INTERMEDIATE # 5 - P PARAMEDIC

YES NO 12 M MEDICAL CONTROL Notify Medical Control Notify Coroner Notify Law Enforcement if not present on YES Known or suspected chest injury? scene

NO Bilateral P P Spinal Immobilization Procedure Chest Decompression

IV Protocol I I Normal Saline bolus EARLY Appropriate Go to NOTIFICATION Protocol YES Return of Spontaneous Circulation? TO TRAUMA CENTER IF NO POSSIBLE

I Continue Normal Saline bolus I

Consider: Reduction of long bone fracture (Hare traction) Stabilization of pelvic fracture (T-pod or sheet) Control of external hemorrhage

Contact Medical Control and Notify M M Destination

PEARLS ü Injuries obviously incompatible with human life include decapitation, massively deforming head or chest injuries, or other features of a particular patient encounter that would make resuscitation futile. If in doubt, place patient on monitor and contact Medical Control ü Consider using cardiac arrest protocols if uncertainty exists regarding medical or traumatic cause of arrest ü As with all major trauma patients, transport should not be delayed ü Where use of spinal immobilization interferes with quality CPR, make reasonable efforts to manually limit patient movement

TRINITY EMS SYSTEM PREHOSPITAL GUIDELINES 2012 2/2015