Trauma – Key Considerations




Trauma: General Burn Care Considerations Crush Injuries Eye Injuries and Exposures
Hypoperfusion/Hypovolemia Smoke Inhalation – Symptomatic Suspected Carbon Monoxide Exposure


Trauma: General

Key Points/Considerations
• Trauma Arrest patients go to the closest appropriate hospital
• All other major trauma patients go to closest appropriate Trauma Center
• Patients with unmanageable airway go to the closest hospital or call for air medical
or advanced airway assistance while enroute to closest hospital
• UNSTABLE patients should be enroute to the hospital/landing zone within 10
minutes of disentanglement/extrication
• If more than 30 minutes from a Trauma Center consider air medical assistance.
Refer to the Aeromedical Utilization Policy
• If more than 45 minutes from Trauma Center and air medical assistance is not
available, transport patient to the closest hospital
• All times start at the time the EMS provider determined the patient to meet major
trauma criteria
• Notify the receiving facility as early as possible giving brief description of
mechanism of injury, status of patient(s), and estimated time of arrival
• Tourniquets are approved for use in extremity trauma in New York State at the BLS
• Hemostatic dressings are approved for use in New York State at the BLS level

Trauma: Burn Care Considerations

Key Points/Considerations
• Be alert for other injuries, including cardiac dysrhythmias
• Be alert for smoke inhalation and airway burns
• Assure 100% oxygen. Oxygen saturation readings may be falsely elevated.
• If hazardous materials, notify the destination hospital immediately to allow for
• When considering total area of a burn, DO NOT count first degree burns
• Burns > 10% are only to be dressed with simple sterile dressings
Transportation Considerations
• Burns associated with trauma should go to the closest appropriate trauma center
• If there is any question about the appropriate destination of a patient consult a
Medical Control Physician
Consider direct transport to a burn center if:
• >10% BSA partial thickness burns (do not count first degree burns)
• Involvement of face, hands, feet, genitalia, or major joints
• Circumferential extremity burns
• Third

Trauma: Burn Care Considerations

Key Points/Considerations
• Signs and symptoms of a Tension Pneumothorax: absent lung sounds on one side,
extreme dyspnea AND hemodynamic compromise, and may include jugular vein
distention, cyanosis, tracheal deviation
• Advanced EMTs in tactical EMS may be trained and equipped for decompression
but the agency must be approved by the REMAC
• Hemodynamic compromise: hypotension, narrowed pulse pressure and tachycardia
• Thoracic decompression is a serious medical intervention that requires a chest tube
in the hospital
• Every thoracic decompression performed must be reviewed with the medical
director and flagged for Regional QI review
• Thoracic decompression should only be performed with a > 3.25” 14G IV catheter

Trauma: Crush Injuries

Key Points/Considerations
• Contact the Regional Trauma Center early and consider physician response to the
scene if anticipated prolonged extrication.
• Use one dedicated IV for Sodium Bicarbonate, the other IV for other medications
• Hyperkalemia is indicated by PVC’s, peaked T-waves or widened QRS complexes
• After extrication immobilize the extremity and apply cold therapy. Do not elevate
the extremity
• *D5W is not on the standard formulary. Must obtain from hospital and have
brought to the scene if needed

Trauma: Eye Injuries and Exposures

Key Points/Considerations
• If hazardous materials, notify the destination hospital immediately to allow for
• Do not put any pressure on the eye when covering with a shield or patch

Trauma: Hypoperfusion/Hypovolemia

Key Points/Considerations
COMPENSTATED SHOCK in trauma is defined as significant mechanism of injury
AND tachypnea, tachycardia, pallor, or restlessness, AND Systolic BP greater than
90 mmHg, MAP > 60 mmHg
DECOMPENSATED SHOCK is defined as clinical picture of shock AND Systolic
BP less than 90 mmHg, MAP < 60
• A falling BP is a LATE sign of shock
• Contact receiving hospital early, with “Trauma Alert” call, giving brief description
of mechanism of injury, status of patient and estimated time of arrival
• Consult physician if guidance of care or orders are needed

Trauma: Smoke Inhalation – Symptomatic

Key Points/Considerations
• Hydroxycobalamin (CyanoKit) is not available in all ambulances. It may be
available for response to scenes through County Fire and EMS Coordinators.
• Drawing bloods is of increased importance prior to CyanoKit administration, as it
can alter laboratory test results
• Suspect cyanide toxicity in patients who were in enclosed spaces during a fire and
have soot in their nares or oropharynx and exhibit altered mental status
• Disorientation, confusion, and severe headache are potential indications of cyanide
poisoning IN THE SETTING of smoke inhalation
• Hypotension without other obvious cause IN THE SETTING of smoke inhalation
increases the likelihood of cyanide poisoning
• Do not delay transport awaiting a CyanoKit. It is available at most EDs.
• For IO administration, placing a stopcock on the IV tubing will allow use of syringe
to draw medication from the bottle and inject into the IO line

Trauma: Suspected Carbon Monoxide Exposure

Key Points/Considerations – Massimo RAD-57
• Pediatrics – The Masimo RAD-57 is not intended for patients weighing <30 kg
• Pregnant Women – The fetal SpCO may be 10-15% higher than the maternal
• Smokers – Heavy smokers may have baseline SpCO levels up to 10%
• A misapplied or dislodged sensor may cause inaccurate readings
• Never use tape to secure the sensor
• Do not place the sensor on the thumb or 5th digit
Key Points/Considerations
• The Massimo RAD-57 or other FDA approved objective carbon-monoxide
evaluation tool may be used to guide therapy
• There is no commercial endorsement implied by this protocol