BLS
- Begin Initial Medical Care.
- Follow Airway Management Protocol.
- Consider oxygen administration.
- Record LOC using AVPU method. Obtain an initial GCS as early as possible.
- Control all significant external bleeding. If direct pressure, elevation, and pressure points do not rapidly stop the bleeding in an extremity, apply a tourniquet. See Tourniquet protocol.
- Direct pressure is the method of choice to control bleeding.
- If bleeding continues despite tourniquet use or wound is not amenable to tourniquet placement (e.g. groin or armpit), pack the wound cavity with a sterile gauze roll and apply direct pressure with a pressure bandage.
- Providers may also utilize a TCCC-approved gauze based hemostatic dressing (e.g., Combat Gauze,) iF available. See Wound Packing protocol.
- The number of dressings packed into the wound must be documented in the patient care record.
- Expose patient to perform a detailed physical exam.
- Cover and keep patient warm between assessments in order to conserve body heat.
- If patient’s presentation, or the mechanism of injury, meets Trauma Alert Criteria:
- Call for a paramedic unit. If transport time is less than ALS unit arrival, start transport as soon as possible.
- Rapidly extricate with cervical spine immobilization.
- Try to keep scene time to 10 minutes or less. If scene time exceeds 10 minutes, document the reason for the delay.
- Patients with major multiple system trauma or penetrating trauma to the head, neck, chest or abdomen should be transported to a Trauma Center. Patients with serious burns should consider ATU for direct transport to a Burn Center. If the patient can be transported by BLS to a Trauma Center in less time than it would take for ALS to arrive, then transport by BLS.
ALS
- During transport - Establish 2 large bore IV's of 0.9% NaCl. Titrate fluids to a SBP of 90 mmHg
- Apply cardiac monitor
- Intubation with C-spine control may be necessary to maintain a patent airway and/or to prevent aspiration of vomitus. Do not nasally intubate patients with facial trauma.
- If an IV cannot be established and an urgent need for vascular access exists, establish IO access.