TRAUMA

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Dampen gauze with sterile saline. Place in a watertight container, place container in ice water, if available. DO NOT FREEZE OR USE DRY ICE.\u003cbr\u003e\nc.\tPartial amputations should be dressed and splinted in alignment with the extremity to assure optimum blood flow.\u003cbr\u003e\n3.\tRapidly transport the patient and readily available amputated tissue to appropriate medical facility. Consider the use of aeromedical evacuation early to expedite the transport process to definitive care.\u003cbr\u003e\nAEMT / PARAMEDIC\u003cbr\u003e\n1.\tIn route, initiate IV/IO access, may use one or two large bore IV (determined by patient condition) of an isotonic fluid, infused at flow rate to maintain adequate end organ perfusion.\u003cbr\u003e\n2.\tFor use of analgesics, see Pain Management Treatment Guidelines.","adBanner":{"ad_banner_enable":0,"banner":"","redirect_url":""},"mapThirdParty":"0","MapThirdParty":"0","reviewRating":1,"attributesForList":[],"directoryInfo":[],"formIdentifier":"default","formType":"custom","widgetInfo":{"widget_enable":null,"widget_label":"Widget Label","widget_code":null},"listOwner":"","claimStatus":null,"pwaUrl":"https://www.lcfdapp.com/services_1582148118880_5/2114007/2128883/10049265"},{"listId":10049269,"catId":2128883,"dirPageId":"services_1582148118880_5","distance":"","chatUrl":"","chatType":"","header":"BURNS-CHEMICAL","summary":"","detail":"BURNS - CHEMICAL INJURY\u003cbr\u003e\nALL LEVELS\u003cbr\u003e\n\u003cbr\u003e\nDESIGNATION OF CONDITION\u003cbr\u003e\nSigns and symptoms include the following: evidence of dry or liquid chemical contamination, and reddening and/or blistering of the skin.\u003cbr\u003e\nEMPHASIS ON PATIENT CARE\u003cbr\u003e\nDecontamination, prevention of further injury and exposure, safety of providers, substance identification if possible.\u003cbr\u003e\n\u003cbr\u003e\n1.\tAssess the scene for safety. Do not enter area until it has been determined safe for the EMT to have immediate contact with patient.\u003cbr\u003e\n\u003cbr\u003e\n2.\tPrimary Management - Assess ABC’s and manage as indicated.\u003cbr\u003e\na.\tDecontaminate by irrigating with water.\u003cbr\u003e\ni.\tRemove all contaminated clothing.\u003cbr\u003e\nii.\tBrush away dry chemical, prior to irrigating.\u003cbr\u003e\niii.\tIrrigate for minimum of 20 minutes.\u003cbr\u003e\n3.\tRemove jewelry and clothing prior to transport.\u003cbr\u003e\n4.\tTransport to appropriate medical facility.\u003cbr\u003e\n5.\tSecondary Management - History, physical exam, vital signs\u003cbr\u003e\na.\tEstimate percentage of Body Surface Area (BSA).\u003cbr\u003e\nb.\tAssess for additional associated trauma.\u003cbr\u003e\nAEMT / PARAMEDIC\u003cbr\u003e\n1.\tIn route, initiate one or two large bore IV or IO (determined by patient condition) of an isotonic solution titrate to maintain adequate end organ perfusion.\u003cbr\u003e\n\u003cbr\u003e\n2.\tFor use of narcotic analgesics, see Pain Management Treatment Guidelines. \u003cbr\u003e\n\u003cbr\u003e\n3.\tMaintain body warmth post irrigation. \u003cbr\u003e\n\u003cbr\u003e\n4.\tDo not apply electrodes to burned skin areas.","adBanner":{"ad_banner_enable":0,"banner":"","redirect_url":""},"mapThirdParty":"0","MapThirdParty":"0","reviewRating":1,"attributesForList":[],"directoryInfo":[],"formIdentifier":"default","formType":"custom","widgetInfo":{"widget_enable":null,"widget_label":"Widget Label","widget_code":null},"listOwner":"","claimStatus":null,"pwaUrl":"https://www.lcfdapp.com/services_1582148118880_5/2114007/2128883/10049269"},{"listId":10049267,"catId":2128883,"dirPageId":"services_1582148118880_5","distance":"","chatUrl":"","chatType":"","header":"BURNS-THERMAL","summary":"","detail":"BURNS\t- THERMAL INJURIES\u003cbr\u003e\n\u003cbr\u003e\nALL LEVELS\u003cbr\u003e\n\u003cbr\u003e\nDESIGNATION OF CONDITION\u003cbr\u003e\nSigns and symptoms may include any one or all of the following: Partial thickness - burns involving the epidermal and dermal layers characterized by reddening or blistering skin. Full thickness - burns involving all skin layers, muscle fascia, and/or charred black or grayish skin, dry in appearance.\u003cbr\u003e\n\u003cbr\u003e\n\u003cbr\u003e\nEMPHASIS ON PATIENT CARE\u003cbr\u003e\nAirway management, fluid replacement, and transport to a burn center after stabilization. Stop the burning process and remove from source.\u003cbr\u003e\n\u003cbr\u003e\n1.\tPrimary Management - Assess ABC’s and manage as indicated.\u003cbr\u003e\na.\tInitiate transport to appropriate medical facility. Consider air evacuation and contact medical control for destination decisions.\u003cbr\u003e\n\u003cbr\u003e\n2.\tSecondary Management - History, physical exam, vital signs\u003cbr\u003e\na.\tFor partial or full thickness Burns, estimate percentage of body surface area (BSA) involved using the Palm Principle (1 palm of patient = 1% BSA) or rule of 9’s\u003cbr\u003e\nb.\tRemove jewelry and clothing unless adhered to skin.\u003cbr\u003e\nc.\tPlace dry sterile dressings over burns, with no two burned surfaces touching.\u003cbr\u003e\nd.\tMaintain body temperature.\u003cbr\u003e\ne.\tFlush eye burns continuously with Normal Saline\u003cbr\u003e\n\u003cbr\u003e\n3.\tFor burns \u003c10% BSA\u003cbr\u003e\na.\tApply sterile dressing, moisten with NS or sterile water, or water gel/aquacool\u003cbr\u003e\n\u003cbr\u003e\n4.\tFor burns \u003e10% BSA\u003cbr\u003e\na.\tApply DRY sterile dressing and DO NOT moisten\u003cbr\u003e\n\u003cbr\u003e\nAEMT\u003cbr\u003e\n\u003cbr\u003e\n1.\tIn route, initiate a large bore IV of Lactated Ringers.\u003cbr\u003e\na.\tInitiate a second IV in an unburned area if possible and if patient condition warrants. \u003cbr\u003e\n2.\tIf \u003e 20% BSA affected or patient is hypotensive administer fluids: 5 or younger: 125 ml./hr., 6-13: 250 ml./hr., and 14 or older: 500 ml./hr.\u003cbr\u003e\n3.\tFor use of narcotic analgesics, see Pain Management Treatment Guidelines.\u003cbr\u003e\n\u003cbr\u003e\n\u003cbr\u003e\nPARAMEDIC\u003cbr\u003e\n\u003cbr\u003e\n1.\tWith facial or airway involvement (singed nasal hair, soot inside nares, stridor etc.) early invasive airway management should be considered. \u003cbr\u003e\na.\tSee Airway Management Procedure Guidelines and Pain Management Treatment Guidelines.\u003cbr\u003e\n2.\tConsider cyanide poisoning in smoke inhalation given the following signs and symptoms (prevalence):\u003cbr\u003e\na.\tUnresponsiveness (78%); Respiratory failure (73%), Hypotension (54%), Cardiac arrest or seizures (20%), Cyanosis or Almond odor (15%), or Cherry colored skin (11%).\u003cbr\u003e\nb.\tHYDROXOCOBALAMIN IV 5gm. administered IV/IO over 30 minutes.\u003cbr\u003e\nc.\tIntubation and vasopressors often required in cyanide poisoning.\u003cbr\u003e\n3.\tAttempt not to apply electrodes to burned areas.\u003cbr\u003e\n4.\tUnless the method of injury involved traumatic forces, transport should be to the closest facility, where airway and pain management, fluid replacement, and transfer to a burn center can be arranged.","adBanner":{"ad_banner_enable":0,"banner":"","redirect_url":""},"mapThirdParty":"0","MapThirdParty":"0","reviewRating":1,"attributesForList":[],"directoryInfo":[],"formIdentifier":"default","formType":"custom","widgetInfo":{"widget_enable":null,"widget_label":"Widget Label","widget_code":null},"listOwner":"","claimStatus":null,"pwaUrl":"https://www.lcfdapp.com/services_1582148118880_5/2114007/2128883/10049267"},{"listId":10049281,"catId":2128883,"dirPageId":"services_1582148118880_5","distance":"","chatUrl":"","chatType":"","header":"CARDIAC ARREST TRAUMA","summary":"","detail":"TRAUMA CARDIAC ARREST \u003cbr\u003e\n\u003cbr\u003e\nALL LEVELS\u003cbr\u003e\n\u003cbr\u003e\nDESIGNATION OF CONDITION\u003cbr\u003e\nSigns and symptoms include an unresponsive patient with absent carotid pulses with a high suspicion of traumatic origin.\u003cbr\u003e\n\u003cbr\u003e\nEMPHASIS ON PATIENT CARE\u003cbr\u003e\n Effective CPR, ACLS intervention, possible decision to terminate resuscitation\u003cbr\u003e\nVerify that the mechanism of injury is consistent with the patient presentation and the cause of arrest\u003cbr\u003e\n\u003cbr\u003e\n1.\tPrimary Management - Assess ABC’s and manage as indicated.\u003cbr\u003e\na.\tC- spine precautions\u003cbr\u003e\nb.\tInitiate CPR, ventilate with 100% OXYGEN.\u003cbr\u003e\n\u003cbr\u003e\n2.\tContact medical control if patient meets criteria for Termination of Resuscitative Efforts Guidelines.\u003cbr\u003e\n\u003cbr\u003e\n3.\tTransport the patient as soon as possible to the nearest medical facility, consider ALS intercept if transport time \u003e 10 minutes.\u003cbr\u003e\na.\tInsert airway (follow Airway Management Procedure Guidelines).\u003cbr\u003e\n•\tConsider supraglottic airway. LMA preferred.\u003cbr\u003e\nb.\tTurn the defibrillator/monitor on and apply defibrillation electrodes.\u003cbr\u003e\nc.\tAnalyze the ECG rhythm.\u003cbr\u003e\nd.\tIf patient is in V-Fib or Pulseless V-Tach., follow Medical Cardiac Arrest Treatment Guidelines if arrest is not due to obvious trauma. Remember the arrest may have preceded trauma and may be the underlying cause.\u003cbr\u003e\n4.\tFor traumatic arrest deemed appropriate for transport, all interventions beyond CPR, and spinal restrictions should be performed in-route to receiving facility to minimize scene time. Assess risk of CPR in-route before initiating transport.\u003cbr\u003e\n AEMT\u003cbr\u003e\n5.\tIn route, initiate two large bore IV or IO access lines administering an isotonic solution.\u003cbr\u003e\n\u003cbr\u003e\n\u003cbr\u003e\n\u003cbr\u003e\nPARAMEDIC\u003cbr\u003e\n6.\tPlace a Supraglottic Airway or ETT in accordance with the corresponding Airway Management Guidelines, allowing no disruption of chest compressions during placement. Managing the airway with BLS techniques is appropriate if good ventilation is achieved.\u003cbr\u003e\n\u003cbr\u003e\n7.\tConsider reasons patient may be in arrest and rule out reversible causes.\u003cbr\u003e\n\u003cbr\u003e\n8.\tIf chest trauma suspected perform bilateral needle chest decompressions in the second intercostal space in the mid-clavicular line early in the resuscitation. \u003cbr\u003e\n\u003cbr\u003e\n9.\tIf patient is in V-Fib or Pulseless V-Tach., follow Medical Cardiac Arrest Treatment Guidelines if arrest is not due to obvious trauma. Remember the arrest may have preceded trauma and may be the underlying cause.\u003cbr\u003e\n\u003cbr\u003e\n10.\tFollow Termination of Resuscitation guidelines with on-line medical direction if needed.\u003cbr\u003e\n\u003cbr\u003e\n11.\tH’s \u0026 T’s\u003cbr\u003e\n\u003cbr\u003e\nHypovolemia\u003cbr\u003e\nHypoxia\u003cbr\u003e\nHydrogen Ion (acidosis)\u003cbr\u003e\nHyper-/hypokalemia\u003cbr\u003e\nHypothermia.\u003cbr\u003e\nToxins\u003cbr\u003e\nTamponade (cardiac)\u003cbr\u003e\nTension pneumothorax\u003cbr\u003e\nThrombosis (coronary and pulmonary)","adBanner":{"ad_banner_enable":0,"banner":"","redirect_url":""},"mapThirdParty":"0","MapThirdParty":"0","reviewRating":1,"attributesForList":[],"directoryInfo":[],"formIdentifier":"default","formType":"custom","widgetInfo":{"widget_enable":0,"widget_label":"Widget Label","widget_code":""},"listOwner":"","claimStatus":null,"pwaUrl":"https://www.lcfdapp.com/services_1582148118880_5/2114007/2128883/10049281"},{"listId":10049271,"catId":2128883,"dirPageId":"services_1582148118880_5","distance":"","chatUrl":"","chatType":"","header":"CRUSH INJURY","summary":"","detail":"CRUSH INJURIES\u003cbr\u003e\nALL LEVELS\u003cbr\u003e\n\u003cbr\u003e\nDESIGNATION OF CONDITION\u003cbr\u003e\nCompression of extremities or other parts of the body for \u003e1 hr that causes muscle swelling and/or neurological disturbances in the affected areas of the body. Crush syndrome is localized crush injury with systemic manifestations.\u003cbr\u003e\nEMPHASIS ON PATIENT CARE\u003cbr\u003e\nCrush injury is very painful, see PAIN MANGEMENT GUIDELINES. EKG changes associated with hyperkalemia: peaked T waves, QRS \u003e 0.12, loss of P wave, “bizarre” wide complex. Patients may easily become hypothermic.\u003cbr\u003e\n\u003cbr\u003e\n1.\tAssess the scene for safety. Do not enter area until it has been determined safe for the EMT to have immediate contact with patient.\u003cbr\u003e\n\u003cbr\u003e\n2.\tPrimary Management - Assess ABC’s and manage as indicated.\u003cbr\u003e\n\u003cbr\u003e\n3.\tEvaluate for spinal restriction\u003cbr\u003e\n4.\tTreat for shock\u003cbr\u003e\n5.\tCheck distal pulses frequently\u003cbr\u003e\n6.\tControl exsanguinating hemorrhage\u003cbr\u003e\nAEMT:\u003cbr\u003e\n\u003cbr\u003e\n1.\tEstablish IV fluid therapy and provide bolus prior to releasing the crushed body part\u003cbr\u003e\na.\t1-2 L NS bolus then titrate to hypotension.\u003cbr\u003e\n2.\tGoal to maintain SBP greater than 90.\u003cbr\u003e\nPARAMEDIC:\u003cbr\u003e\n\u003cbr\u003e\n1.\tIf patient is entrapped for longer than 60 min infuse NS at 1000ml/hr and give 1 amp of Bicarbonate\u003cbr\u003e\n2.\tProvide appropriate pain control.\u003cbr\u003e\n3.\tMay give MIDAZOLAM 2-4 mg IV/IO/IM/IN for anxiety.\u003cbr\u003e\n4.\tApply EKG and monitory for EKG changes and hyperkalemia. See HYPERKALEMIA in Medical Section.","adBanner":{"ad_banner_enable":0,"banner":"","redirect_url":""},"mapThirdParty":"0","MapThirdParty":"0","reviewRating":1,"attributesForList":[],"directoryInfo":[],"formIdentifier":"default","formType":"custom","widgetInfo":{"widget_enable":0,"widget_label":"Widget Label","widget_code":""},"listOwner":"","claimStatus":null,"pwaUrl":"https://www.lcfdapp.com/services_1582148118880_5/2114007/2128883/10049271"},{"listId":10049274,"catId":2128883,"dirPageId":"services_1582148118880_5","distance":"","chatUrl":"","chatType":"","header":"EYE INJURY","summary":"","detail":"EYE INJURIES\u003cbr\u003e\nALL LEVELS:\u003cbr\u003e\n\u003cbr\u003e\n1.\tLacerations on or near the eyelid or eye:\u003cbr\u003e\na.\tDo not apply pressure to the eyeball.\u003cbr\u003e\nb.\tCover BOTH eyes with a loose dressing.\u003cbr\u003e\nc.\tPreserve avulsed parts in a clean plastic bag.\u003cbr\u003e\n2.\tForeign bodies:\u003cbr\u003e\na.\tNon-impaled: Cover BOTH eyes with loose dressing.\u003cbr\u003e\nb.\tImpaled: DO NOT REMOVE - stabilize with a paper cup and bulky dressing (donut). Cover unaffected eye.\u003cbr\u003e\n3.\tAvulsed eye: \u003cbr\u003e\na.\tCover with sterile moist dressings; use sterile saline, Ringer’s Lactate, or sterile water. Cover unaffected eye.\u003cbr\u003e\n1.\tChemical burns: \u003cbr\u003e\na.\tIrrigate copiously with tap water, saline, or Ringer’s Lactate as soon as possible, minimum of 2L. \u003cbr\u003e\nPARAMEDIC: \u003cbr\u003e\n\u003cbr\u003e\n1.\tConsider application of cardiac monitor due to potential involvement of cranial nerves with deep penetrating eye trauma. Treat lethal dysrhythmias concurrently.\u003cbr\u003e\n2.\tConsider Pain Management Guidelines","adBanner":{"ad_banner_enable":0,"banner":"","redirect_url":""},"mapThirdParty":"0","MapThirdParty":"0","reviewRating":1,"attributesForList":[],"directoryInfo":[],"formIdentifier":"default","formType":"custom","widgetInfo":{"widget_enable":null,"widget_label":"Widget Label","widget_code":null},"listOwner":"","claimStatus":null,"pwaUrl":"https://www.lcfdapp.com/services_1582148118880_5/2114007/2128883/10049274"},{"listId":10049276,"catId":2128883,"dirPageId":"services_1582148118880_5","distance":"","chatUrl":"","chatType":"","header":"HEAD INJURY","summary":"","detail":"HEAD INJURIES\u003cbr\u003e\nDESIGNATION OF CONDITION\u003cbr\u003e\n\u003cbr\u003e\nTraumatic brain injury (TBI) is a cerebral insult from an external mechanical force, possibly leading to permanent or temporary impairment of cognitive, physical, and psychosocial functions, with an associated diminished or altered state of consciousness. Concussions are periods of confusion or LOC associated with trauma which may have resolved by the time EMS arrives.\u003cbr\u003e\n\u003cbr\u003e\nEMPHASIS ON PATIENT CARE\u003cbr\u003e\n1.\tIncreased ICP may cause HTN and bradycardia (Cushing’s response), do not treat HTN\u003cbr\u003e\n2.\tHypotension usually indicates injury or shock unrelated to the head injury\u003cbr\u003e\n3.\tMonitor and document a change in the level of consciousness\u003cbr\u003e\n4.\tLimit IV fluids unless the patient is hypotensive\u003cbr\u003e\n5.\tA single episode of hypoxia, defined as SpO2 \u003c 90% at any time, has been shown in numerous studies to increase death and disability in moderate to severe TBI.\u003cbr\u003e\nBLS:\u003cbr\u003e\n\u003cbr\u003e\n1.\tPrimary Management - Assess ABC’s and manage as indicated.\u003cbr\u003e\n\u003cbr\u003e\n2.\tEvaluate for Cervical Spine field clearance.\u003cbr\u003e\n3.\tAdminister oxygen; assist ventilations if needed. SpO2 should be at 100%. Avoid hyperventilation: maintain PCO2 at 35-45 range.\u003cbr\u003e\nAEMT:\u003cbr\u003e\n1.\tEstablish an IV of LR or NS.\u003cbr\u003e\n2.\tAvoid hypoxia: administer 02 to maintain oxygen saturation at 100%.\u003cbr\u003e\n3.\tAvoid hypotension: ideal BP unknown but should be above 90 systolic and higher if possible\u003cbr\u003e\n4.\tAvoid hyperventilation: maintain End Tidal CO2 between 35 and 45.\u003cbr\u003e\nPARAMEDIC:\u003cbr\u003e\n1.\tApply cardiac monitor; treat lethal dysrhythmias concurrently to injury treatments. \u003cbr\u003e\nNote:\tAvoid the three “H Bombs” of TBI: hypoxia, hypotension, and hyperventilation.","adBanner":{"ad_banner_enable":0,"banner":"","redirect_url":""},"mapThirdParty":"0","MapThirdParty":"0","reviewRating":1,"attributesForList":[],"directoryInfo":[],"formIdentifier":"default","formType":"custom","widgetInfo":{"widget_enable":0,"widget_label":"Widget Label","widget_code":""},"listOwner":"","claimStatus":null,"pwaUrl":"https://www.lcfdapp.com/services_1582148118880_5/2114007/2128883/10049276"},{"listId":10049272,"catId":2128883,"dirPageId":"services_1582148118880_5","distance":"","chatUrl":"","chatType":"","header":"HEMORRHAGE EXTERNAL","summary":"","detail":"HEMORRHAGE CONTROL \u003cbr\u003e\n\u003cbr\u003e\nDESIGNATION OF CONDITION\u003cbr\u003e\nAny wound that creates circulatory shock due to blood loss may need application of tourniquet. Symptoms include: pallor, AMS, hypotension, weak pulses, cool clammy skin or physical signs of severe uncontrollable hemorrhage, amputation or near amputation.\u003cbr\u003e\n\u003cbr\u003e\nALL PROVIDERS\u003cbr\u003e\n\u003cbr\u003e\n1.\tApply direct pressure to the injury\u003cbr\u003e\na.\tIf this is effective dress the wound and elevate extremity\u003cbr\u003e\nb.\tIf this is ineffective proceed with protocol\u003cbr\u003e\n\u003cbr\u003e\n2.\tIf wound is amenable to tourniquet placement:\u003cbr\u003e\na.\tApply tourniquet 3 inches above the wound\u003cbr\u003e\nb.\tIf first tourniquet does not control hemorrhage apply second tourniquet above first\u003cbr\u003e\nc.\tDo not release tourniquet until definitive care is at bedside\u003cbr\u003e\n\u003cbr\u003e\n3.\tIf wound is not amenable to tourniquet placement\u003cbr\u003e\na.\tApply hemostatic dressing into wound and apply direct pressure directly to bleeding source\u003cbr\u003e\n\u003cbr\u003e\n4.\tHemodialysis access sites may result in life threatening hemorrhage. Direct digital pressure with hemostatic dressing should be used first followed by tourniquet in the setting of life threatening hemorrhage when other means of hemorrhage control have been unsuccessful\u003cbr\u003e\n\u003cbr\u003e\n5.\tTreat pain according to pain protocol. Tourniquets are rapidly very painful.\u003cbr\u003e\n\u003cbr\u003e\n6.\tIf significant non-compressible hemorrhage continues consider TXA administration within three hours of start of hemorrhage)\u003cbr\u003e\n\u003cbr\u003e\nAdult Initial Bolus (16 years and older).\u003cbr\u003e\n\u003cbr\u003e\n\tMix 2 grams vial in 250 ml. of fluid.\u003cbr\u003e\nAdminister 2 grams (250 ml.) IV/IO over 10 minutes.","adBanner":{"ad_banner_enable":0,"banner":"","redirect_url":""},"mapThirdParty":"0","MapThirdParty":"0","reviewRating":1,"attributesForList":[],"directoryInfo":[],"formIdentifier":"default","formType":"custom","widgetInfo":{"widget_enable":0,"widget_label":"Widget Label","widget_code":""},"listOwner":"","claimStatus":null,"pwaUrl":"https://www.lcfdapp.com/services_1582148118880_5/2114007/2128883/10049272"},{"listId":10049279,"catId":2128883,"dirPageId":"services_1582148118880_5","distance":"","chatUrl":"","chatType":"","header":"MULTISYSTEM TRAUMA","summary":"","detail":"TRAUMA (MULTIPLE SYSTEMS)\u003cbr\u003e\nALL LEVELS\u003cbr\u003e\nDESIGNATION OF CONDITION\u003cbr\u003e\nSigns and symptoms may include any or all of the following: mechanism of injury suggestive of trauma to two or more body systems.\u003cbr\u003e\nEMPHASIS ON PATIENT CARE\u003cbr\u003e\n1.\tPrimary Management - Assess ABC’s and manage as indicated.\u003cbr\u003e\na.\tStabilize airway if necessary: oral / nasal airway; SGA; suction\u003cbr\u003e\n2.\tControl of hemorrhage, inspection of C-spine, minimize scene time\u003cbr\u003e\na.\tApply pelvic binder if hypotensive and evidence of pelvic injury\u003cbr\u003e\nb.\tConsider use of tourniquet as indicated\u003cbr\u003e\n3.\tInitiate transport to appropriate medical facility. Consider aeromedical evacuation to definitive care. If in doubt, contact medical control.\u003cbr\u003e\n4.\tSecondary Management - History, physical exam, vital signs\u003cbr\u003e\n5.\tConsider traction splint for mid-shaft femur fractures\u003cbr\u003e\n6.\tImmobilize long bone fractures\u003cbr\u003e\n7.\tCover patient to prevent hypothermia\u003cbr\u003e\n8.\tCover suspected open chest wounds with an occlusive dressing. Stabilize fractured and/or flail segments.\u003cbr\u003e\na.\tBe vigilant for developing tension pneumothorax. If a tension pneumothorax is suspected, release the seal over the wound and allow any air under pressure to escape. Then reseal the wound and monitor the patient.\u003cbr\u003e\n\u003cbr\u003e\nAEMT\u003cbr\u003e\n1.\tIn-route, initiate one or two large bore IVs of an isotonic solution and infuse at a flow rate to maintain adequate end organ perfusion.\u003cbr\u003e\n\u003cbr\u003e\n2.\tUtilize a Buretrol in PEDIATRICS at rate of 20 ml./kg. administered as a bolus. Repeat as needed. If unable to initiate a peripheral IV, consider intraosseous access if patient condition warrants\u003cbr\u003e\n\u003cbr\u003e\n3.\tFor use of analgesics, see Pain Management Guidelines.\u003cbr\u003e\n\u003cbr\u003e\nPARAMEDIC\u003cbr\u003e\n1.\tConsider airway management: ET intubation, SGA or surgical airway.\u003cbr\u003e\n2.\tConsider chest decompression for suspected pneumothorax. Consider bilateral in cardiac arrest.\u003cbr\u003e\n3.\tSee Pain Management Guidelines\u003cbr\u003e\n4.\tSee Airway Management Treatment Guidelines.\u003cbr\u003e\n5.\tFor significant suspected or overt non-compressible hemorrhage consider TXA administration within three hours of onset of hemorrhage:\u003cbr\u003e\n\u003cbr\u003e\nAdult Initial Bolus (16 years and older)\u003cbr\u003e\n\u003cbr\u003e\nMix 2 grams vial in 250 ml. bag of fluid.\u003cbr\u003e\nAdminister 2 grams (250 ml.) IV/IO over 10 minutes.","adBanner":{"ad_banner_enable":0,"banner":"","redirect_url":""},"mapThirdParty":"0","MapThirdParty":"0","reviewRating":1,"attributesForList":[],"directoryInfo":[],"formIdentifier":"default","formType":"custom","widgetInfo":{"widget_enable":0,"widget_label":"Widget Label","widget_code":""},"listOwner":"","claimStatus":null,"pwaUrl":"https://www.lcfdapp.com/services_1582148118880_5/2114007/2128883/10049279"},{"listId":10049277,"catId":2128883,"dirPageId":"services_1582148118880_5","distance":"","chatUrl":"","chatType":"","header":"SPINAL IMMOBILIZATION","summary":"","detail":"SPINAL IMMOBILIZATION\u003cbr\u003e\nALL LEVELS\u003cbr\u003e\nYou may elect to withhold spinal restriction and discontinue all spinal stabilization efforts if your patient meets ALL of the following criteria. Criteria includes seated patients when considering use of KED. Proceed immediately with spinal stabilization if patient fails to meet ANY of the following:\u003cbr\u003e\n1.\tPatient Reliability:\u003cbr\u003e\na.\tConscious, alert, and well oriented, not under suspicion or the influence of drugs, alcohol, or any other mind-altering substance.\u003cbr\u003e\nb.\tLegal adult or emancipated minor, and has no language or communication problems.\u003cbr\u003e\nc.\tNo suspicion of other major distracting injury.\u003cbr\u003e\nd.\tNo suspicion of head/brain injury. \u003cbr\u003e\n2.\tAssess Spinal Column:\u003cbr\u003e\na.\tNo complaints of pain, tenderness, numbness, etc., upon thorough palpation of the entire spinal column.\u003cbr\u003e\nb.\tSpinal column has no visible or palpable abnormalities\u003cbr\u003e\n3.\tAssess Sensory and Motor Function:\u003cbr\u003e\na.\tNo sensory deficit.\u003cbr\u003e\nb.\tNo motor deficit\u003cbr\u003e\n4.\tIf the patient fails the above criteria place a C-collar and:\u003cbr\u003e\na.\tIf ambulatory assist to stretcher\u003cbr\u003e\nb.\tIf non-ambulatory use rigid extrication device as needed to move patient to stretcher and then remove device if possible.\u003cbr\u003e\n5.\tUtilize C-collar if patient is \u003e65 y/o.\u003cbr\u003e\n•\tLong spine boards (LSB) have not been shown to improve patient outcomes. The best use of the LSB is as an extrication device for the unconscious patient.\u003cbr\u003e\n•\tPatients should not be immobilized on a LSB, however if unconscious and/or unresponsive maintain use of LSB to aid in patient extrication and transport to hospital by EMS.\u003cbr\u003e\n•\tPatients with penetrating trauma and no evidence of spinal injury do not require spinal immobilization.\u003cbr\u003e\n•\tPatients who are ambulatory at the scene of blunt trauma in general do not require immobilization via LSB, but may require C-collar and spinal precautions.\u003cbr\u003e\n•\tSpinal precautions are very important in patients at risk for spinal injury. Adequate spinal precautions may be achieved by placement of a hard-cervical collar and safeguarding that the patient is secured to the stretcher, ensuring minimal movement. During patient transfers maintain manual in-line stabilization during any transfers.\u003cbr\u003e\n•\tIf a patient is ambulatory on scene or if they can safely self-extricate, apply a c-collar and allow them to do so. \u003cbr\u003e\n•\tNo patient should be left on a backboard during transport unless more harm may be done by removal of the board.\u003cbr\u003e\n•\tIf patient is unconscious or unresponsive may utilize back board and immobilization to facilitate patient transfer.","adBanner":{"ad_banner_enable":0,"banner":"","redirect_url":""},"mapThirdParty":"0","MapThirdParty":"0","reviewRating":1,"attributesForList":[],"directoryInfo":[],"formIdentifier":"default","formType":"custom","widgetInfo":{"widget_enable":null,"widget_label":"Widget Label","widget_code":null},"listOwner":"","claimStatus":null,"pwaUrl":"https://www.lcfdapp.com/services_1582148118880_5/2114007/2128883/10049277"},{"listId":10049278,"catId":2128883,"dirPageId":"services_1582148118880_5","distance":"","chatUrl":"","chatType":"","header":"TBI","summary":"","detail":"TBI\u003cbr\u003e\nALL LEVELS\u003cbr\u003e\nDESIGNATION OF CONDITION\u003cbr\u003e\nSigns and symptoms may include any or all of the following: slowing pulse rate, increasing blood pressure, increasingly irregular respiratory patterns, altered level of consciousness, unequal pupils, repeating speech patterns, seizures, presence of CSF, with a history of head trauma.\u003cbr\u003e\n\u003cbr\u003e\nEMPHASIS ON PATIENT CARE\u003cbr\u003e\nAirway management, adequate oxygenation, spinal precautions\u003cbr\u003e\nBe aware of the potential for spinal, abdominal or chest trauma not apparent due to altered mental status.\u003cbr\u003e\n\u003cbr\u003e\n1.\tPrimary Management - Assess ABC’s and manage as indicated. Avoid the three H-Bombs of TBI: Hypoxia, Hypotension, and Hyperventilation.\u003cbr\u003e\n2.\tSecondary Management - History, physical exam, vital signs, and Glasgow Coma Scale.\u003cbr\u003e\n\u003cbr\u003e\nAEMT\u003cbr\u003e\n\u003cbr\u003e\n3.\tIn route, initiate an IV/IO of an isotonic solution at a rate to maintain end organ perfusion. Consider second IV, if indicated.\u003cbr\u003e\n4.\tUse a Buretrol IV set for PEDIATRICs. Consider intraosseous access, if peripheral venous access is not available and patient conditions warrants.\u003cbr\u003e\nPARAMEDIC\u003cbr\u003e\na.\tPEARLS:\u003cbr\u003e\nPrevention of hypoxia, hypotension, and hyperventilation (the three “H-bombs” of TBI) are imperative to prevent secondary brain injury.\u003cbr\u003e\nIntubation should be approached with caution as it has been associated with worse outcomes when performed in the out-of-hospital environment for some patients with traumatic brain injury.\u003cbr\u003e\nBoth hypoxia and hyperoxia have been associated with increased mortality and worse discharge GCS scores in TBI (traumatic brain injury) patients.\u003cbr\u003e\nHyperventilation causes a decrease in the cerebral blood flow by vasoconstriction as a result of decreased levels of C02 (which is a vasodilator).\u003cbr\u003e\nHypoxia: maintain Pulse Ox of 100%. Hypotension: maintain BP systolic above 90. Optimal BP not known but higher is better in moderate to severe TBI. Do not hyperventilate: maintain End Tidal CO2 between 35 and 45.\u003cbr\u003e\nTXA not routinely recommended for isolated TBI.","adBanner":{"ad_banner_enable":0,"banner":"","redirect_url":""},"mapThirdParty":"0","MapThirdParty":"0","reviewRating":1,"attributesForList":[],"directoryInfo":[],"formIdentifier":"default","formType":"custom","widgetInfo":{"widget_enable":0,"widget_label":"Widget Label","widget_code":""},"listOwner":"","claimStatus":null,"pwaUrl":"https://www.lcfdapp.com/services_1582148118880_5/2114007/2128883/10049278"},{"listId":13528111,"catId":2128883,"dirPageId":"services_1582148118880_5","distance":"","chatUrl":"","chatType":"","header":"TRAUMA ASSESSMENT (GENERAL)","summary":"","detail":"TRAUMA ASSESSMENT (GENERAL)\u003cbr\u003e\nGeneral\u003cbr\u003e\nThe assessment of a trauma patient differs significantly from that of a medical patient. Issues like time management, rapid physical assessment, and timely transport are important. When dispatched to a “trauma patient” little information is made available often to the responding EMT. Trauma can produce isolated injury, generalized injuries, immediate life threats, and even traumatic arrest. \u003cbr\u003e\nAssessment\u003cbr\u003e\nAny level of EMT is capable of a proper trauma assessment. Time is of the essence.\u003cbr\u003e\n1.\tA full history may not be available from the patient or bystanders or family. The mechanism of injury is important to determine with as much detail as possible. Chief complaints, past medical history, and medication may be spotty or unavailable. The primary medication that may be relevant is a blood thinner (Eliquis, Xarelto, Warfarin). If possible, attempt to determine if a medical incident caused the ensuing trauma. These scenes may be chaotic and a team approach with proper delegating of tasks can be helpful.\u003cbr\u003e\n2.\tThe primary survey (ABC’s) is easily conducted.\u003cbr\u003e\n3.\tA rapid secondary (head-to-toe) examination is indicated.\u003cbr\u003e\na.\tAs much as can be practically done the patient should be exposed.\u003cbr\u003e\nb.\tThe first order of business is to look for potential life threats including abnormal vital signs (hypotension, tachycardia, tachypnea, low oxygen saturation, and altered mental status).\u003cbr\u003e\nc.\tSigns of hemorrhage, both external and internal, should be sought.\u003cbr\u003e\nd.\tIdentification of signs of blunt trauma to the head, neck, chest, abdomen, pelvis, and extremities should be sought.\u003cbr\u003e\ne.\tPenetrating trauma may be in multiple locations and a search for all entry and exit wounds needs to be conducted.\u003cbr\u003e\nf.\tAs each life-threat is identified an intervention may be called for before further assessment is conducted.\u003cbr\u003e\ng.\tThe assessment may be more complicated if a medical cause of the incident is found or suspected.\u003cbr\u003e\nTreatment\u003cbr\u003e\nTreatment for trauma patients is detailed in other guidelines. Timely transport is often indicated in trauma patients compared to the traditional medical patient where much can be done on-scene.","adBanner":{"ad_banner_enable":0,"banner":"","redirect_url":""},"mapThirdParty":"0","MapThirdParty":"0","reviewRating":1,"attributesForList":[],"directoryInfo":[],"formIdentifier":"default","formType":"custom","widgetInfo":{"widget_enable":null,"widget_label":"Widget Label","widget_code":null},"listOwner":"","claimStatus":null,"pwaUrl":"https://www.lcfdapp.com/services_1582148118880_5/2114007/2128883/13528111"},{"listId":10049962,"catId":2128883,"dirPageId":"services_1582148118880_5","distance":"","chatUrl":"","chatType":"","header":"TRAUMA DESIGNATION","summary":"","detail":"TRAUMA DESIGNATION\u003cbr\u003e\nDetermining how (air or ground) and where (local or El Paso) to transport is an important consideration. It is still the responsibility of the first responding, highest level, EMT to make the determination if it is in the patient’s best interest to have a helicopter launched for scene response or if ground transport to the Level 3 Trauma Center (Mountain View) is the most appropriate. Time is of the essence. Helicopter transport takes considerable time commonly and may be best reserved for patients who have had the opportunity for stabilization at the Level 3 center. Mountain View’s capabilities may change in the future and a call to them for “Trauma Activation” would reveal if the patient in question would be acceptable to them.\u003cbr\u003e\n\u003cbr\u003e\nPHYSIOLOGIC CRITERIA (\"Level 1\")\u003cbr\u003e\nConsider transport to Level 1 or 2 Trauma center if ANY of the following are present:\u003cbr\u003e\n1.\tGlasgow Coma Scale ≤13\u003cbr\u003e\n2.\tSBP \u003c 90mmHg\u003cbr\u003e\n3.\tBreathing \u003c10 or \u003e29 breaths/min (\u003c20 breaths/min if \u003c1 year old)\u003cbr\u003e\n4.\tRequires assisted ventilations\u003cbr\u003e\n\u003cbr\u003e\nANATOMIC CRITERIA (\"Level 1\")\u003cbr\u003e\nConsider transport to Level 1 or 2 Trauma center if ANY of the following are present:\u003cbr\u003e\n1.\tPenetrating injury to head, neck, torso, or extremity proximal to elbow or knee\u003cbr\u003e\n2.\tChest wall instability or deformity (e.g. flail chest)\u003cbr\u003e\n3.\t2 or more proximal long-bone fractures\u003cbr\u003e\n4.\tCrushed, degloved, mangled, or pulseless extremity\u003cbr\u003e\n5.\tAmputation proximal to wrist or ankle\u003cbr\u003e\n6.\tPelvic fractures\u003cbr\u003e\n7.\tOpen or depressed skull fracture\u003cbr\u003e\n8.\tParalysis\u003cbr\u003e\n\u003cbr\u003e\nMECHANISM OF INJURY CRITERIA (\"Level 2\")\u003cbr\u003e\nConsider transport to any level Trauma center if ANY of the following are present and NONE of the PHYSIOLOGIC or ANATOMIC criteria are present:\u003cbr\u003e\n1.\tFalls \u003e20 ft. (\u003e10 feet or 2-3x height for children)\u003cbr\u003e\n2.\tHigh Risk Auto Crash-Intrusion, including roof \u003e 12 inches at occupant site or\u003cbr\u003e\n\u003e18 inches anywhere\u003cbr\u003e\n3.\tEjection (partial or complete) from automobile-Death in same compartment\u003cbr\u003e\n4.\tAuto vs. pedestrian/bicyclist thrown, run over, or with significant (\u003e20 mph) impact\u003cbr\u003e\n5.\tMotorcycle crash \u003e20 mph\u003cbr\u003e\n\u003cbr\u003e\nSPECIAL CONSIDERATIONS/PROVIDER JUDGEMENT \u003cbr\u003e\nConsider transport to appropriate Trauma center if ANY of the following are present:\u003cbr\u003e\n1.\tOlder Adults\u003cbr\u003e\n2.\tAnticoagulants and bleeding disorders\u003cbr\u003e\n3.\tPregnant patients \u003e20 week gestation\u003cbr\u003e\nSPECIAL NOTES\u003cbr\u003e\n\u003cbr\u003e\nIf the ETA of the helicopter is greater than the ground transport to the Level 3 center consider ground transport if that is in the patient’s best interest. If the time difference is insignificant and the patient is clearly a Level 1 or 2 patient consider helicopter response.\u003cbr\u003e\n\u003cbr\u003e\nThe decision of the first on scene EMT with the highest level license should stand and not be countermanded by later arriving EMTs from the fire department or ambulance service except by mutual agreement. If conflict arises consider consulting on-line medical direction from the Level 3 center.\u003cbr\u003e\n\u003cbr\u003e\nAll Level 3 patients can go to Mountain View and if necessary, because of patient volume at Mountain View, to MMC (Level 4 center).","adBanner":{"ad_banner_enable":0,"banner":"","redirect_url":""},"mapThirdParty":"0","MapThirdParty":"0","reviewRating":1,"attributesForList":[],"directoryInfo":[],"formIdentifier":"default","formType":"custom","widgetInfo":{"widget_enable":0,"widget_label":"Widget Label","widget_code":""},"listOwner":"","claimStatus":null,"pwaUrl":"https://www.lcfdapp.com/services_1582148118880_5/2114007/2128883/10049962"}],"data":false,"categoryData":{"catName":"TRAUMA","catId":2128883,"catIcon":""},"parentCategoryData":{"catId":2114007,"catName":"GUIDELINES"}},"match":{"hostname":"www.lcfdapp.com","page":"services_1582148118880_5","category":"2128883"}}},"page":"/[...slug]","query":{"slug":["services_1582148118880_5/2128883"]},"buildId":"1234567890","isFallback":false,"dynamicIds":[1204],"customServer":true,"gip":true,"scriptLoader":[]}