lesson 10

Lesson 10Summation

Putting It All Together

Key Points (1 of 4)

• Safety of providers and patients– Number one priority

• Prearrival preparedness and scene assessment– Assessment begins before arriving at the scene

• Sufficient resources?– How many patients are involved?– Are there special scene needs?

Key Points (2 of 4)

• Access to patient• General impression

– History and mechanism of injury (kinematics)• Identify immediate life threats and manage

them– Primary assessment

• Transport and destination decisions

Key Points (3 of 4)

• Physically immobilize the patient as needed– Manually, then mechanically

• Patient extrication• Assess and treat identified injuries and

resulting conditions– Principles versus preferences

• Transportation and destination• Communication and documentation

Key Points (4 of 4)

• Principle is what needs to be done for a patient based upon the assessment.

• Preference is how the principle is accomplished.– This will change depending on the:

• Situation at the scene• Severity of the patient• Knowledge and skills of the prehospital care

provider• Resources available

Identify and Manage Immediate Life Threats (1 of 5)

• Airway and breathing– Manually stabilize

cervical spine as indicated

– Suction as needed– Provide supplemental

oxygen early– Support ventilations

as necessary


• Airway and breathing (cont’d)– Use simple interventions before complex

• Example: Bag-mask device before intubation– Ventilate before and between intubation

attempts– Maintain a proper rate of ventilation


• Circulation– Control obvious bleeding

• Conserve red blood cells• Immobilize major fractures

– Maintain body temperature


• Circulation (cont’d)– IVs can be started while en route– Provide no more fluid than necessary

• Avoid over-resuscitation that can lead to increased blood loss


• Disability– Maintain manual cervical stabilization until

immobilization is complete– Calculate GCS score– Reassess for changes in the patient’s

condition over time

Transportation andDestination (1 of 2)

• Patient handling– Identify patients requiring rapid extrication– Maintain manual stabilization while performing

extrication– Recognize the limitations of immobilization

devices– Maintain a team approach

• Transportation– Transport to appropriate destination without

delay– Utilize appropriate transport method and

mode

Transportation andDestination (2 of 2)

Communication and Documentation

• Communication– Provide clear, concise, accurate, timely, and

complete communication with the receiving facility

• Documentation– Complete documentation is important for

continued care, research, and accountability

Potential Pitfalls (1 of 2)

• Ignoring or failing to recognize scene hazards

• Focusing on distracting, non-life-threatening injuries

• Performing secondary assessment before life-threatening conditions have been assessed and managed

• Not performing a secondary assessment when indicated

Potential Pitfalls (2 of 2)

• Missing life-threatening conditions by not exposing and assessing the patient

• Not maintaining body temperature• Prolonged scene times• Inappropriate selection of destination

Golden Principles (1 of 7)

• Ensure the safety of the prehospital care providers and the patient

• Assess the scene situation to determine the need for additional resources


• Recognize the kinematics that produced the injuries

• Use the primary assessment to identify life-threatening conditions Courtesy of Mark Woolcock


• Provide appropriate airway management while maintaining cervical spine stabilization as indicated

• Support ventilation and deliver oxygen to maintain an SpO2 greater than 95%


• Control any significant external hemorrhage

• Provide basic shock therapy, including appropriately splinting musculoskeletal injuries and restoring and maintaining normal body temperature


• Maintain manual spinal stabilization until the patient is immobilized

• For critically injured trauma patients, initiate transport to the closest appropriate facility as soon as possible after EMS arrival on scene

Courtesy of Rick Brady


• Initiate warmed intravenous fluid replacement en route to the receiving facility

• Ascertain the patient’s medical history and perform a secondary assessment when life-threatening problems have been satisfactorily managed or have been ruled out

• Provide adequate pain relief


• Provide thorough and accurate communication regarding the patient and the circumstances of the injury to the receiving facility

• Above all, do no further harm

“Our patients did not choose us. We chose them.”

“We have accepted this responsibility . . . we must give to our patients the very best care that we can.”

“We must be ready to treat our patients by learning from our experiences and the science provided by prehospital research.”

Norman E. McSwain, MDMedical Director, PHTLS

Courtesy Norman McSwain, MD, FACS,NREMT-P

Questions?

lesson 10

Health & Medicine