Trauma Tip of the Month – May 2025

Trauma is the leading cause of death in adults under 45. In North America, 50 million people receive some sort of trauma related care, with 30% of those people accounting for all hospital admissions.  Prehospital care of trauma patients focuses on addressing immediate life threats, rapid assessments, key interventions, and appropriate and timely transport to minimize and prevent further injury and mortality.

Prehospital Trauma Management

Rapid Assessment (ABCDE approach)

This is a systematic evaluation of a patient’s condition to identify life threatening injuries.

• Airway with Cervical Spine Protection
  • Assess for patency; protect cervical spine during airway management
  • Consider supraglottic or endotracheal airway if the airway is compromised and BLS maneuvers fail
  • Ensure no foreign objects, blood or secretions in the airway
  • Use cervical collars or manual stabilization for suspected spinal injuries
• Breathing and Ventilation
  • Check for symmetrical chest rise, breath sounds and use of accessory muscles
  • Assess for potential injuries like pneumothorax or flail chest
  • Auscultate in at least two locations per lung to detect pneumothorax or hemothorax
  • Apply an occlusive dressing when necessary
  • Avoid over-ventilation, particularly in head injuries – target ETCO2 35-45mmHg
• Circulation with Hemorrhage Control
  • Assess pulse, blood pressure, and signs of external or internal bleeding
  • Immediate interventions: initiate hemorrhage control using direct pressure, tourniquets and hemostatic dressings as indicated
• Disability/Neurological status
  • Conduct a rapid neurological exam
  • Assess verbal response, pupil size/reaction and motor function
• Exposure and Environmental Control
  • Fully expose the patient to identify hidden injuries
  • Take appropriate steps to prevent hypothermia – remove wet clothing, insulate the patient with blankets, and prevent any further heat loss
  • Prevent the “trauma triad of death”: hypothermia, acidosis, coagulopathy

 Transport and Handover Considerations

• Minimize on-scene time < 10mins for unstable patients
• Consider air transport where applicable
• Provide a structured trauma handover
  • Age/Name
  • Time of incident
  • MOI
  • Injuries found
  • Vital Signs
  • Treatments provided

 Common Mistakes in Trauma Care

 Overlooking ongoing bleeding

• Failing to fully expose the patient
• Not reassessing bleeding control measures appropriately
• Distracting injuries

Misjudging airway patency

• Making assumptions about a patient's airway because they are able to speak
• Not reassessing the airway
• Not utilizing BLS airway maneuvers or airway adjuncts

Missing subtle signs of decompensation

• Not noticing subtle changes in respiratory rate or mental status
• Not performing frequent reassessments of vital signs
• Not recognizing downward trends in vital signs

Performing a rapid and systematic trauma assessment using the ABCDE approach, coupled with continuous reassessment, is essential to identify changes in the patient's presentation and determine the effectiveness of interventions, thereby mitigating these common mistakes and improving patient outcomes.