Introduction:
Major road-traffic accidents (like car crashes), gunshot wounds, serious falls, and other unintentional and intentional injuries can cause traumas that require emergency medical attention. These major traumas may lead to the loss of a body part, deep wounds, fractures, organ damage, and even death if not treated immediately. Such traumatic injuries must be managed quickly, and the injured must be transported to a trauma center for immediate medical treatment. Emergency care for patients with major trauma is a tough job and requires various stages and levels of expert care.
What Are the Key Principles of Managing a Trauma Patient?
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Emergency care must be initiated promptly.
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Major life-threatening injuries must be treated first.
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Time is a crucial factor.
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It is enough to diagnose the clinical signs first (a complete diagnosis with imaging is not mandatory to initiate treatment).
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The emergency team must - assess the patient, intervene and then reassess.
What Is the Golden Hour for Emergency Care?
The first hour after the accident is referred to as the golden hour. The patient must be transferred to trauma care and must receive a definitive diagnosis and treatment within the first hour to improve the chance of survival. Major trauma is one of the common causes of death. Time plays a crucial role in determining survival. A person can die within seconds to minutes if there are savage injuries to the brain, heart, large blood vessels, and other important organs. There are certain life-threatening injuries that can cause death within minutes to hours later and significant blood loss. The lives of trauma patients with such injuries can be saved when definitive treatment is given in the golden hour.
What Emergency Care Is Provided Initially?
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The first quick assessment of the seriously injured at the first contact is called primary assessment. All the major injuries, fractures, and deep wounds that can be life-threatening are identified, and immediate medical treatment is initiated.
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The top priority in trauma care is keeping the airway patent (open) and keeping the patient breathing. The patient’s breathing and vital signs are assessed. If the patient is unconscious, their airway is secured, and breathing assistance is provided.
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Steps are taken to control bleeding.
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Measures are taken to normalize the patient’s blood pressure and body temperature. Initiating fluid resuscitation, giving oxygen, getting intravenous access and other simple procedures are life-saving when done immediately.
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Prompt initiation of medical care creates time for definitive treatment and complex procedures.
What Are the Steps to Manage a Trauma Patient?
A systematic approach helps to quickly and efficiently manage and treat trauma. Triage is done in case there are many people involved in the accident. The patient’s airway, breathing, circulation, disability, and environment are assessed to initiate treatment immediately. The patient is then transferred to a hospital or trauma care. The injured are examined completely upon reaching the trauma center, along with their medical history. The patient is also monitored constantly and reevaluated to assess his condition. After arriving at a definitive diagnosis, appropriate medical treatment and procedures are performed.
The key steps in the entire process include the following:
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Rapid first aid and basic trauma life support.
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Advanced trauma life support.
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Transfer to trauma centers.
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Definitive care and treatment.
What Are Trauma Centers and Their Types?
Trauma centers are hospitals that have doctors specialized in treating life-threatening traumatic injuries like head injury, multiple trauma, and injuries due to a crash or falling objects. These centers are of five levels depending on the staff expertise and the equipment available. These include:
1) Level One Trauma Center:
These hospitals provide total care for all aspects of the injury (prevention to rehabilitation). They have the most comprehensive services (to assess, manage and treat) and also work to improve trauma care. The complex elements and services of a level one trauma center include the following:
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Expert doctors and surgeons in all specialties for emergency and critical care of trauma patients (available 24 hours).
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They provide an extensive assessment facility to handle critical and complex injuries.
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They are equipped with emergency rooms, critical care units, and operation theaters with all the necessary equipment to provide complete care.
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They provide public awareness and educate the communities around them about the means to prevent trauma.
2) Level Two Trauma Center:
These centers assess and initiate care for the injured. They also have experts and specialists available around the clock. Trauma patients requiring advanced care like heart surgery or dialysis are sent to the level one center after initiating definitive care. These centers also work to improve emergency trauma care.
3) Level Three Trauma Center:
These centers promptly assess the injured, resuscitate, and stabilize them. They also perform emergency operations and provide intensive care. Emergency physicians are available 24 hours a day. They have limited facilities and transfer patients requiring advanced care to level one or two centers after stabilizing them.
4) Levels Four and Five Trauma Centers:
These centers evaluate, stabilize and diagnose trauma patients and provide emergency advanced life support. They have trauma nurses and physicians available to care for the injured and then transfer them to a higher-level trauma center.
How Are the Injured Transported to Trauma Centers?
The emergency team assesses the injured before initiating life-saving measures. The patient is then transported to an emergency care or trauma care center for definitive diagnosis and treatment. The information on the patient’s arrival and status (details of the injury, medical history, any complications, and the immediate medical care initiated) is reported to the trauma center or hospital. The patient can be transported by road or air (helicopter service - air ambulance). Transport by air is quicker but not the safest option available. Also, the use of air ambulances requires helipads near hospitals. A complete assessment of the situation and the patient’s condition is necessary to decide the mode of transport. Usually, road ambulances are safer and quicker, considering the delay in organizing the air ambulance.
Conclusion:
As trauma is an unexpected event, the treatment’s goal is to help the patient survive and get back to normal function without any disabilities. The savage injuries that can cause loss of life can be identified by the emergency team at the first contact. Simple medical procedures, when initiated without delay, help extend the patient’s survival till definitive care is given at the trauma center. A complete clinical assessment of the trauma is done in the trauma centers, and definitive procedures are performed by experts to save a trauma patient. Emergency management of serious or multiple injuries is a tough process that requires well-coordinated and efficient emergency care from the staff and expert doctors on time.
