Trauma Care Pre-Hospital Manual

Cover......Page 1
Half Title......Page 2
Title Page......Page 4
Copyright Page......Page 5
Dedication......Page 6
Table of Contents......Page 8
Introduction
......Page 10
Abbreviations and acronyms
......Page 12
Contributors
......Page 18
The big picture
......Page 20
Climate change and energy use
......Page 22
Natural disasters
......Page 23
War
......Page 24
Terrorism
......Page 26
Organised crime and civilian violence
......Page 27
Globalisation, trauma systems and education
......Page 28
References
......Page 29
Getting to the scene safely
......Page 33
The Safety 123
......Page 34
2 – Scene
......Page 35
3 – Patient
......Page 36
E- Evaluation and re-evaluation
......Page 37
Occupational exposure to blood-borne pathogens
......Page 38
Personal protective equipment
......Page 39
Sharps management
......Page 40
Equipment and Drug Safety
......Page 41
Helicopter safety
......Page 42
Weather
......Page 44
Motorways
......Page 46
Acts of aggression
......Page 47
Post-incident debriefing
......Page 48
References
......Page 49
Taking the call and setting out
......Page 50
The approach
......Page 51
Principles of scene management
......Page 53
Undertaking the consultation
......Page 54
Vehicle accidents and entrapment
......Page 55
En route to hospital
......Page 57
Summary
......Page 58
Introduction
......Page 59
Communication and responding to the trauma call
......Page 60
Initial communication on scene
......Page 61
Radio voice procedure
......Page 62
What is CRM?
......Page 63
Concepts of CRM
......Page 64
Airwave
......Page 65
Communication on arrival at the receiving unit
......Page 66
Joint Emergency Services Interoperability Programme (JESIP)
......Page 67
Further reading
......Page 68
Introduction
......Page 69
The physics of energy transfer
......Page 70
Kinetic energy and blunt trauma
......Page 71
Vehicle occupant collisions
......Page 72
Pedestrian collisions
......Page 73
Falls from a height
......Page 74
Blunt injuries by region
......Page 75
Kinetic injury and penetrating trauma
......Page 76
Use of mechanism of injury
......Page 77
References
......Page 78
Introduction
......Page 80
 – Catastrophic haemorrhage
......Page 81
A – Airway (with cervical spine control)
......Page 82
B – Breathing
......Page 83
Palpation
......Page 84
C – Circulation
......Page 85
D – Disability
......Page 86
Summary
......Page 88
References
......Page 89
Introduction
......Page 91
Control of junctional bleeding
......Page 92
Direct pressure
......Page 93
Factor concentrators
......Page 94
Mucoadhesive agents
......Page 95
Windlass tourniquets
......Page 96
Tourniquet application
......Page 97
Junctional tourniquets
......Page 98
References
......Page 99
Introduction
......Page 102
The Airway
......Page 103
Inhalational Injuries
......Page 104
Obstructed Respiration
......Page 105
Listen
......Page 106
Manual Manoeuvres
......Page 107
Oropharyngeal Airway (OPA)
......Page 108
Intermediate Airway Manoeuvres
......Page 109
Endotracheal Intubation
......Page 110
Cricoid Pressure versus BURP
......Page 111
Difficult or Failed Airway
......Page 113
Summary
......Page 114
References
......Page 115
Immediately life-threatening chest injuries
......Page 117
Penetrating trauma
......Page 118
Chest wall
......Page 119
Look
......Page 120
Listen
......Page 122
Management
......Page 123
Open pneumothorax
......Page 124
Management
......Page 125
Management
......Page 126
Management
......Page 127
Aortic (and other great vessel) injury
......Page 128
Diaphragmatic injury
......Page 129
Sternal fracture
......Page 130
Transport
......Page 131
References
......Page 132
Introduction
......Page 134
Hypovolaemic shock
......Page 135
The body’s response to shock
......Page 136
The clinical approach to the trauma patient
......Page 137
Clinical management
......Page 140
Decompensated hypovolaemic shock
......Page 141
Summary
......Page 142
References
......Page 143
Introduction
......Page 144
Rapid access
......Page 145
Stage 1: Scene assessment and scene safety
......Page 146
Stage 4: Space creation
......Page 147
Stage 5: Full access
......Page 148
Extricating the driver
......Page 149
Method 2
......Page 150
Alternative extrication techniques
......Page 151
Immobilisation
......Page 152
Rules for clearing C-spine
......Page 153
Packaging
......Page 154
Further Reading
......Page 155
Introduction
......Page 157
Static loading
......Page 158
Subdural haematoma (SDH)
......Page 159
Neurophysiological effects of traumatic brain injury
......Page 160
Approaches to the classification of TBI
......Page 161
Initial assessment and management of TBI
......Page 162
Cervical spine immobilisation
......Page 163
Breathing
......Page 164
Disability
......Page 165
Additional interventions
......Page 166
Head injury in children
......Page 167
References
......Page 168
Mechanisms of injury
......Page 170
Anatomy
......Page 171
Primary and secondary injury
......Page 173
Immobilisation
......Page 176
Ongoing management
......Page 177
Management of penetrating trauma
......Page 178
Packaging and transport
......Page 179
Paediatric spinal injury
......Page 180
References
......Page 181
Epidemiology
......Page 184
Assessment
......Page 185
Digital photography
......Page 186
Immediately life-threatening musculoskeletal injuries
......Page 187
Splints
......Page 188
Crush injuries
......Page 189
In-hospital management
......Page 190
Clavicular fracture
......Page 191
Dislocated elbow
......Page 192
The hip
......Page 193
The pelvis
......Page 194
Lower leg fractures
......Page 195
References
......Page 196
Analgesia
......Page 198
Non-pharmacological
......Page 199
Pharmacological
......Page 200
Paracetamol
......Page 201
Local anaesthetics (Las)
......Page 202
Sedation
......Page 204
Drugs for sedation
......Page 206
Pre-hospital emergency anaesthesia
......Page 207
Preparing for anaesthesia
......Page 208
Adjuncts
......Page 209
References
......Page 210
Introduction
......Page 213
Airway
......Page 214
Breathing
......Page 216
Disability
......Page 217
Airway
......Page 218
Head injury
......Page 219
Spinal injury
......Page 220
Abdominal injury
......Page 221
Extremities
......Page 222
Access
......Page 223
Traumatic cardiorespiratory arrest
......Page 224
Analgesia
......Page 225
Intranasal
......Page 227
Principles
......Page 228
Safeguarding
......Page 229
References
......Page 230
Mechanisms of injury
......Page 232
Circulation
......Page 233
Placental abruption
......Page 234
Foeto-maternal haemorrhage
......Page 235
Assessing fundal height
......Page 236
Catastrophic haemorrhage control
......Page 237
Circulation
......Page 238
Maternal cardiac arrest following trauma
......Page 239
Summary
......Page 240
References
......Page 241
The epidemiology of trauma in the elderly
......Page 242
Mechanism of injury in elderly trauma
......Page 243
Physiological response to trauma in the elderly
......Page 244
Past medical history and drug history
......Page 245
Injury scores and mortality in elderly trauma patients
......Page 246
References
......Page 247
Scene safety
......Page 252
Types of burn
......Page 253
Wallace Rule of Nines
......Page 254
Lund and Browder chart
......Page 255
Airway
......Page 256
Circulation
......Page 257
Hypothermia mitigation
......Page 258
Electrical burns
......Page 259
Summary
......Page 260
Further reading
......Page 261
Epidemiology
......Page 262
Firearms
......Page 263
External ballistics
......Page 265
Bullet instability
......Page 266
Permanent cavity
......Page 267
Cavitation and temporary cavity formation
......Page 268
Bullet design and energy transfer
......Page 269
Ballistic mesh
......Page 270
Scene safety and command and control
......Page 271
History and assessment
......Page 272
Pre-hospital treatment
......Page 273
Further reading
......Page 274
Blast injuries in war and peace
......Page 275
Blast incidents in the civilian setting
......Page 276
Shock Wave
......Page 277
Primary blast injury
......Page 278
Blast Incident Management
......Page 279
Summary
......Page 280
References
......Page 281
Introduction
......Page 283
Equipment
......Page 284
Secondary care
......Page 285
Infrastructure and transport platforms
......Page 286
Planning
......Page 287
How much treatment can be done in one episode before resupply?
......Page 288
Understanding the patient journey
......Page 289
Anaesthesia and airway maintenance
......Page 290
Resuscitation fluids and strategies
......Page 291
Analgesia
......Page 292
Prolonged field care
......Page 293
Summary
......Page 294
References
......Page 295
Introduction
......Page 297
Resilience and preparation
......Page 298
The all hazards approach
......Page 299
MIMMS principles: methane and CSCATTT
......Page 300
Strategic command
......Page 301
Operational command
......Page 302
Personal safety
......Page 303
Communication
......Page 304
Social media
......Page 305
Triage
......Page 306
Triage sieve
......Page 307
Triage sort
......Page 308
Triage accuracy
......Page 309
Treatment at the scene
......Page 310
Diagnosis of death
......Page 311
Evacuation
......Page 312
Mode of transport
......Page 313
MERIT: Medical Emergency Response Incident Team
......Page 314
Summary
......Page 315
References
......Page 316
Pre-transfer management and triage
......Page 318
Deciding on most appropriate transport method
......Page 319
Patient packaging for retrieval
......Page 320
Equipment for transfer
......Page 321
Rotary wing patient transfer
......Page 322
Fixed wing patient transfer
......Page 324
References
......Page 325
Introduction
......Page 327
Hospital handover
......Page 328
Digital technology
......Page 329
Patient report forms
......Page 330
Content
......Page 331
Refusal of care or non-hospital attendance
......Page 332
Contemporaneous notes
......Page 333
Electronic patient report form (ePRF)
......Page 334
Audiovisual recording
......Page 335
Disclosure with consent
......Page 336
The police
......Page 337
Summary
......Page 338
References
......Page 339
Further Reading
......Page 340
Introduction
......Page 341
Legal accountability
......Page 342
Common law
......Page 343
Consent and capacity
......Page 344
Consent and capacity: Children
......Page 345
Negligence
......Page 346
Conclusion
......Page 347
References
......Page 348
Introduction
......Page 349
Clinical questions
......Page 350
Combining existing knowledge to produce robust evidence
......Page 351
Summarising evidence
......Page 352
Preparation and planning
......Page 355
Prospective or retrospective clinical audit
......Page 356
Data collection and analysis
......Page 357
References
......Page 358
Further reading
......Page 359
Introduction
......Page 360
Role of the PHEM practitioner
......Page 361
The PHEM Curriculum
......Page 363
Sub-specialty theme 1: Working in emergency medical systems
......Page 364
Medical training in PHEM
......Page 365
Summary
......Page 366
Further reading
......Page 367
Introduction
......Page 368
Early Development in the United Kingdom
......Page 369
Progress Elsewhere
......Page 370
General Characteristics of Trauma
......Page 371
The Frequency and Types of Major Trauma
......Page 372
Generic requirements and guiding principles
......Page 373
Ambulance Services and Enhanced Care Teams
......Page 374
Designated Hospitals for Major Trauma
......Page 375
The Trauma Pathway
......Page 376
Pre-hospital Triage and Transport to the Most Appropriate Hospital
......Page 378
The Major Trauma Reception Team in the Major Trauma Centre (MTC) or Trauma Unit (TU)
......Page 379
Consultation with and referral to the MTC
......Page 380
Secondary Transfer to the MTC
......Page 381
Peer Review
......Page 382
Leadership and Involvement Culture
......Page 383
Education and Training
......Page 384
Conclusion
......Page 385
References
......Page 386
Procedure
......Page 388
Procedure
......Page 389
Procedure
......Page 390
References
......Page 392
Initial assessment
......Page 393
Step 3: Identify life-threatening chest trauma
......Page 394
Step 5: Identify and manage (or exclude) long bone fractures
......Page 395
Return of spontaneous circulation (ROSC)
......Page 396
Index
......Page 397