1. Begin Initial Medical Care.
  2. Follow Airway Management Protocol.
  3. Consider oxygen administration.
  4. Record LOC using AVPU method. Obtain an initial GCS as early as possible.
  5. 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.
  6. Direct pressure is the method of choice to control bleeding.
  7. 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.
  8. Providers may also utilize a TCCC-approved gauze based hemostatic dressing (e.g., Combat Gauze,) iF available. See Wound Packing protocol.
  9. The number of dressings packed into the wound must be documented in the patient care record.
  10. Expose patient to perform a detailed physical exam.
  11. Cover and keep patient warm between assessments in order to conserve body heat.
  12. If patient’s presentation, or the mechanism of injury, meets Trauma Alert Criteria:
  13. Call for a paramedic unit. If transport time is less than ALS unit arrival, start transport as soon as possible.
  14. Rapidly extricate with cervical spine immobilization.
  15. Try to keep scene time to 10 minutes or less. If scene time exceeds 10 minutes, document the reason for the delay.
  16. 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.
  17. BEGIN ALS 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.
  18. If an IV cannot be established and an urgent need for vascular access exists, establish IO access.