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HomeHealth articlestraumaWhat Are the Key Principles of Managing a Trauma Patient?

Trauma and Emergency Care

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Major traumas can cause life-long disabilities or death if prompt emergency treatment is not initiated. Simple procedures are life-saving when done immediately.

Medically reviewed by

Dr. Kaushal Bhavsar

Published At October 28, 2022
Reviewed AtMay 30, 2024

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?

  • Emergency care must be initiated promptly.

  • Major life-threatening injuries must be treated first.

  • Time is a crucial factor.

  • It is enough to diagnose the clinical signs first (a complete diagnosis with imaging is not mandatory to initiate treatment).

  • 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?

  • 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.

  • 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.

  • Steps are taken to control bleeding.

  • 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.

  • 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:

  1. Rapid first aid and basic trauma life support.

  2. Advanced trauma life support.

  3. Transfer to trauma centers.

  4. 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:

  • Expert doctors and surgeons in all specialties for emergency and critical care of trauma patients (available 24 hours).

  • They provide an extensive assessment facility to handle critical and complex injuries.

  • They are equipped with emergency rooms, critical care units, and operation theaters with all the necessary equipment to provide complete care.

  • 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.

Frequently Asked Questions

1.

What is emergency trauma care?

Emergency trauma care is the system that delivers time-sensitive health care services at the scene of injury through transport and the medical care provided at the emergency department at the hospitals or trauma care centers. Resuscitation and other interventional procedures delivered on time can help save trauma patients. Emergency care is medical care that ensures timely recognition and treatment initiation for life-threatening, time-sensitive injuries and illnesses.

2.

Is there a difference between a trauma center and an emergency department?

Emergency departments are rooms in a hospital where patients requiring emergency treatment are admitted for immediate medical care. These range from those who have sprained ankles to those with critical life-threatening illnesses such as heart attacks.
Trauma centers handle cases of life-threatening injuries. These centers are equipped with advanced healthcare equipment and specialized doctors and surgeons to ensure the trauma patient's survival.

3.

Is trauma a medical emergency?

Not all traumas are medical emergencies. However, trauma due to serious falls, car crashes, or other major road-traffic accidents, gunshot wounds, and other life-threatening injuries require emergency medical attention. In addition, major traumatic incidents with deep wounds, loss of a body part, organ damage, and fractures are life-threatening emergencies that require emergency care and transportation to a trauma center for expert management.

4.

What Is Trauma Triage, and Why Is It Needed?

Trauma triage is the assessment to prioritize the patients for transport or treatment according to the severity of their injury. There are two types of trauma triage - primary and secondary triage. Primary triage is done at the scene of the accident, and secondary triage is carried out at a major incident site at a casualty clearing station. Trauma triage is usually repeated before transport and at the receiving trauma care center or hospital. Trauma triage is essential to identify patients requiring emergency life-saving interventions to ensure survival.

5.

What Are the Common Traumatic Injuries Requiring Emergency Care?

The most common traumatic injuries that require emergency care include:
- Motor vehicle collisions (car accidents or road traffic accidents).
- Sports injuries.
- Injuries during natural disasters.
- Other intentional and unintentional injuries occur on the street, at home, or at work.
- Major falls (accidental).
- Gunshot wounds.

6.

What to Do in Case of Trauma?

In case of major traumatic injuries, the following key steps are essential:
- Seeking emergency medical care at the site of injury or accident.
- Treating major injuries that are life-threatening first.
- Initiating medical interventions on time is crucial to ensure patient survival.
- Promptly diagnosing the life-threatening problems in the patient is essential to initiate immediate interventions. A complete diagnosis (with imaging) is not needed to initiate medical care that can save lives.
- Careful assessment, intervention, and reassessment by the emergency medical team are vital.

7.

What Is the Golden-Hour Rule?

Major trauma is life-threatening. The patients can die within seconds to minutes if the injury involves the brain, heart, major blood vessels, and other vital organs. The first hour after an accident or major injury is called the golden hour of emergency care. During the golden hour, the patient must receive resuscitation interventions, transfer to trauma care, and definitive treatment to ensure survival.

8.

What Is the First Priority in Managing Trauma?

The priority in managing traumatic injuries is treating life-threatening injuries first. Therefore, assessing the patient's airway, breathing, circulation, disability, and exposure and initiating resuscitation measures are paramount. Then, the patient must be transferred to a trauma care center to receive definitive treatment.

9.

How to Transfer Trauma Patients?

The emergency medical team assesses the injured patient and initiates life-saving interventions. After this, the patient is transported by air ambulance or road to an emergency trauma care center for definitive treatment. The emergency team reports the patient's details to the hospital. The emergency team decides the mode of transport depending on the patient's condition and availability and after a complete assessment of the situation.

10.

Where to Take Trauma Patients?

Major trauma patients must be taken to trauma centers. These hospitals have specialized doctors who treat life-threatening injuries such as brain and head injuries, crush injuries, multiple trauma with fractures, and others such as major falls. Trauma centers are of five levels based on the availability of the equipment and the staff expertise. The level one trauma centers provide total care from prevention, assessment, management, and treatment to rehabilitation all aspects) of the injury.
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Dr. Kaushal Bhavsar
Dr. Kaushal Bhavsar

Pulmonology (Asthma Doctors)

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