London Ambulance Service Trauma Management PDF

Support the management of trauma in the emergency and urgent care setting - Component 8 Process and Systems of Trauma Process and Systems of Trauma - Component 8 © Department of Clinical Education & 2...

Support the management of trauma in the emergency and urgent care setting - Component 8 Process and Systems of Trauma Process and Systems of Trauma - Component 8 © Department of Clinical Education & 2 Standards Process and Systems of Trauma - Component 8 Objectives Explain the process and the systems in place to effectively manage a trauma patient © Department of Clinical Education & 3 Standards Process and Systems of Trauma - Component 8 What Is Trauma? Trauma is when an injury occurs due to an external source of energy transferring to the body faster than the body can sustain and dissipate it. What Is Major Trauma? When an injury is likely to result in permanent disability or death. © Department of Clinical Education & 4 Standards Process and Systems of Trauma - Component 8 Facts Major trauma is the leading cause of death in patients 20feet) Ejected from vehicle Trapped under vehicle (not motorcycle) Death of same vehicle occupant Traumatic Amputations above wrist or above ankle Other emergency service request (including RNLI) ©Department of Clinical Education & Standards  Process and Systems of Trauma - Component 8 INTERROGATION DISPATCH – 7 minutes to dispatch Fall from height < 2 floors Burns / Scalds RTCs Electrocution Entrapments Industrial accidents Impaled on an object Building site accidents Amputations Explosions Stabbing / Shooting Hangings Drowning Interrogation can be completed passively by calling back the origin for more information, or silently by listening in to the 999 call. ©Department of Clinical Education & Standards Process and Systems of Trauma - Component 8 The major trauma system Ambulance: Trauma Tree used to ensure patients are appropriately transported to a MTC Local hospital for stabilisation if required (unmanageable airway problem) Pre-hospital care is crucial – HEMS and ambulance staff work closely together to provide initial care and ensure patients are in the most appropriate place. © Department of Clinical Education & 13 Standards Process and Systems of Trauma - Component 8 Major Trauma Centre (MTC) A focussed assessment is conducted by a specialist trauma team The trauma team will then perform the necessary life saving interventions Rehabilitation After severe injury reconstructive surgery is often required Personalised rehabilitation programme to help return to an active life from professionals such as: Physiotherapists Occupational therapists Speech and language therapists © Department of Clinical Education & 14 Standards Process and Systems of Trauma - Component 8 To establish good trauma care… Seriousness of the injury identified on scene/as early as possible Transferred to MTC as soon as major trauma recognised CT scans etc. completed immediately on arrival at hospital Appropriate rehabilitation programmed started Good trauma care involves getting to the right place at the right time for the right care. © Department of Clinical Education & 15 Standards Process and Systems of Trauma - Component 8 The role of MTC’s Open 24/7 Consultant led care Access to the best diagnostic and treatment facilities Access to vital rehabilitation after initial treatment © Department of Clinical Education & 16 Standards © Department of Clinical Education & 17 Standards Process and Systems of Trauma - Component 8 Major trauma decision tree Designed to identify and triage patients who may benefit from a specialist trauma centre Two versions (adult and child) Always check the trauma tree before conveying to trauma centre – inappropriate use will block beds and delay ambulance availability When using the trauma tree, the step triggered must be documented on the PRF © Department of Clinical Education & 18 Standards Process and Systems of Trauma - Component 8 Major trauma decision tree -adult Trauma tree can be accessed via: /https://thepulseweb.lond- amb.nhs.uk/news/bulletins/ © Department of Clinical Education & 19 Standards Process and Systems of Trauma - Component 8 Major trauma decision tree- paediatric © Department of Clinical Education & 20 Standards Process and Systems of Trauma - Component 8 What does Mechanism Of Injury (MOI) mean? The MOI is the sum of all physical forces that is exerted on the body which results in an injury. © Department of Clinical Education & 21 Standards Process and Systems of Trauma - Component 8 You will need to establish the MOI for any patient who has been injured. This alone cannot predict or exclude an injury, but will aid your history and assessment of the patient. To establish this you will need to gather information regarding the events leading up to the incident. This may not always be consistent with your findings - highlighting the importance of a good primary/secondary survey. © Department of Clinical Education & 22 Standards Process and Systems of Trauma - Component 8 Types of MOI: Fall from standing/sitting/height Abnormal flexion/extension/rotation of joints (i.e. whiplash or c-spine injuries in a RTC) Blunt trauma (Deceleration and compression force) Penetrating trauma Entrapment © Department of Clinical Education & 23 Standards  Process and Systems of Trauma - Component 8 Significant mechanism: Fall >6m/2 storeys in an adult or fall >3m/2 times height of child Entrapment (relative and absolute) Motor vehicle: Intrusion >30cm on occupants side Ejection from vehicle Death in same passenger compartment Motorcycle crash >20mph Pedestrian/cyclist vs. motor vehicle >20mph When the above are present you must consult the LAS Major Trauma Tree © Department of Clinical Education & 24 Standards Process and Systems of Trauma - Component 8 Special considerations You should have a lower threshold for providing a trauma alert for: A patient aged >55 Pregnant patients >20 weeks Patient’s taking anti-coagulants (e.g. warfarin) or know to have bleeding or clotting disorders Morbidly obese patients Paediatrics 140cm tall or >32kg then treat as an adult Try to keep children with family if possible The Children Act 2004 requires an unaccompanied child to be cared for by ambulance personnel or police, until a social worker is available – NOT a well-meaning member of the public. © Department of Clinical Education & 43 Standards  Process and Systems of Trauma - Component 8 Reporting mechanisms SCENE: METHANE: Used when assessing the Provides initial communication initial trauma scene to enable and details at a major incident effective management M – Major incident declared S – Safety E – Exact location C – Cause (MOI) T – Type of incident E – Environment H – Hazards known or potential N – Number of patients A – Access and egress for vehicles N – Number of casualties E – Extra resources needed E – Emergency services required © Department of Clinical Education & 44 Standards Process and Systems of Trauma - Component 8 This should be on all sun visors in ambulances Windscreen report: Press Priority on airway radio Give EOC your call sign and CAD number Tell them exactly what you can see Follow with a METHANE report © Department of Clinical Education & 45 Standards Process and Systems of Trauma - Component 8 Handover models ATMIST: CATMIST: Used for handover in Used for trauma blue call trauma C - Call sign/CAD A – Age A – Age T – Time of incident T – Time of incident M – Mechanism I – Injuries M – Mechanism S – Signs and Symptoms I – Injuries found T – Treatment S – Vital signs given/immediate needs T – Treatment given © Department of Clinical Education & 46 Standards  Process and Systems of Trauma - Component 8 A format used for handover extensively S within the NHS is SBAR. SBAR: SBAR allows for a logical B sequence of concise information to be handed over A Can be used in many situations. E.g. hospital R handover, on scene handover to arriving crews etc. © Department of Clinical Education & 47 Standards Process and Systems of Trauma - Component 8 The importance of reporting mechanisms Reporting mechanisms such as revised trauma system, SBAR, (C)ATMIST and METHANE allow for clear, concise, appropriate information to be passed to the relevant person. Whether this is someone in control via radio, colleagues or staff in a trauma centre. Reporting mechanisms explain how quickly the patient will require observations and interventions © Department of Clinical Education & 48 Standards Process and Systems of Trauma - Component 8 The importance of an effective and structured handover A handover occurs when you are transferring the care of your patient (therefore passing information about them) to another healthcare professional. If important information is missed then it can lead to errors in treatment and cause harm to the patient The risk of errors increases in high stress situations – when an accurate handover is most important © Department of Clinical Education & 49 Standards Process and Systems of Trauma - Component 8 Tips Ensure you are talking to the person responsible for your patient’s care Make notes in advance to ensure you do not miss vital information Ensure everyone is listening before you start handing over Ensure your handover is clear and concise Write all the information on your PRF to be provided to the hospital when it is complete. © Department of Clinical Education & 50 Standards Process and Systems of Trauma - Component 8 Questions? © Department of Clinical Education & 51 Standards