Do you preform a trauma assessment on all trauma patients

[akflightmedic]

Wait? You back boarded a patient?? With no neck and back complaints!?

And as someone else stated, how the car looks is irrelevant, especially these days. My oldest daughter was just in a major front impact recently, the car which struck her was absolutely destroyed. Her car is totaled. You would have expected some serious injury out of this looking at the vehicles...I LOVE Volvos!

 

[ZombieEMT]

I would have to agree the general opinion of everyone else. Base your whether or not you perform a full trauma assessment, on the condition of the patient. Ask yourself some questions like... What is the mental status of the patient? Do they have any distracting and/or serious injuries? Is there any major bleeding? Are vital signs within normal limits.... Generally once you get the experience, you will learn how to decide within several seconds what is serious and what is not. You will know the patients that warrants a full trauma assessment vs focused assessment. If you see the patient and say "oh crap" full trauma, if you say "bull crap" probably not.

Also think about what you are considering a trauma. Most people are relating this to an MVC, but there are many other types of traumas. You get yours falls, amputations, assaults, etc. Technically cutting off my finger while cooking Thanksgiving dinner is a trauma, but is it trauma center criteria and does it need a full trauma assessment.

 

[ZombieEMT]

Wait? You back boarded a patient?? With no neck and back complaints!?

And as someone else stated, how the car looks is irrelevant, especially these days. My oldest daughter was just in a major front impact recently, the car which struck her was absolutely destroyed. Her car is totaled. You would have expected some serious injury out of this looking at the vehicles...I LOVE Volvos!

I like this response. My medical director has pretty much completely eliminated the long board. Per our protocols, a long board is simply a moving device and should be removed for transport. I am a strong supporter of this.

 

[BeMuc]

1. Ask your medic, what he did and why. Learn.
2. Not every trauma needs a full assessment as in EMS school's standard situations. It's totally situation dependent (see #1).
3. Even getting to the scene and talking to the patient already is part of the assessment.
4. Your medic could be wrong...(see #1).

This already was said in the postings before. I just want to put emphasis on #3. You'll gather information about the scene just the few seconds you get out of your ambulance to the patient. Say "hello" and check the response of your patient (alert, immedeate, appropriate?) - noone else will see that you already did your EMS wizardry. Ask a few questions: "what's your name? how did that happen? how are you?" and again - you have a lot of information about the patient and his reception of the incident, his LOC and possible trauma (especially to the head). Check clothes for bleeding, massive bleeding will be instantly obvious in most cases. Again, noone will notice you already have a lot of medical information about your patient.

An immedeate full trauma assessment is done on unconscious patients or patients who fail to pass the basic tests above. Beside that, you constantly should check your patients condition, and be prepared to switch to full trauma care any moment should it be necessary.

But mostly it's just people having some sort of accident and called EMS "just to be sure" or because it looked like on TV. No need to harass them with the full action you learned in EMS school, where there is no time to talk about all those low-level incidents you will be called to. That's left to the training on the job (see #1 above!!!).

This said, I usually do at least one full assesment in the ambulance (not on the street in full view if not really necessary), even on apparent minor injuries. I simply don't like to be surprised...

(BTW: have a happy new year!)

 

[highglyder]

I'm in training right now

That's a big reason for your uncertainty. As a student, you're train of thought is not wrong, it's what I expect of students and rookies. As you acquire experience, knowledge, and confidence, you'll see that just because it's one call type or another doesn't necessarily mean that you have to follow every step.

For example, if we tend to a patient who tripped and landed on her shoulder and is complaining of pain to that site only, I'm not going to do a full trauma assessment. Why? It's unnecessary and going over and above does not equate good medical care. If she denied any other pain or discomfort and they injury is not distracting in nature, there is no reason that I expose and palpate the abdomen, check her pelvis' stability, or even simple palpate the legs, it would be inappropriate in this particular case.

Listen to your patient. Do for your patient and not to your patient. Time, experience, and exposure will help you know when you need to look everywhere or when you can local.

 

[highglyder]

Well, I couldn't agree more, chaz90. While we do function under protocols, we also need to think about the patient and what's going on with them. There are occasions where the patient seems to fit one protocol but needs another... or needs you to become a bit more creative and actually ask for orders (or suggest them) because the patient doesn't fit any protocol you have available to you.

Case in point. Had a 19 y/o who went out fishing on a boat on a full sun 33 degree day (that's 91 for you imperialists ) wearing jeans and a polo shirt. He was out there for over 6 hours and had zero fluid intake. When he got home, he essentially passed out on the floor after drinking about 500ml of water. He was tachycardic and hypertensive. Such a presentation does not fit our provincial directives for fluid replacement, but that's exactly what he needed as he was heat stroke (dry, not sweated in several hours, altered LOA, etc...). Had I been IV certified at the time, it would of been call the doc. Others would have simply said "He doesn't qualify for fluid therapy". Bummer......

 

[Qulevrius]

For example, if we tend to a patient who tripped and landed on her shoulder and is complaining of pain to that site only, I'm not going to do a full trauma assessment.

I had a similar call literally a week ago. A 81 y.o. F tripped and fell, hitting her shoulder on a recliner (the husband didn't see the fall but heard it and responded immediately). AOS to find her soundly asleep, when awoken stated no pain and/or discomfort, was AxOx4 and neither pain/crepitus on palpation nor any bruising of the affected shoulder girdle, but I still checked for possible head trauma (LOC + PERL + v/s), just in case - even though I was 99% certain it's going to be AMA since she slept on the same shoulder she fell on.

 

[highglyder]

And as someone else stated, how the car looks is irrelevant, especially these days.

The cake box may be crumpled, but the cake is just fine. MOI and how cars look are factors to consider, but not factors that should dictate treatment.

 

[highglyder]

I had a similar call literally a week ago. A 81 y.o. F tripped and fell, hitting her shoulder on a recliner (the husband didn't see the fall but heard it and responded immediately). AOS to find her soundly asleep, when awoken stated no pain and/or discomfort, was AxOx4 and neither pain/crepitus on palpation nor any bruising of the affected shoulder girdle, but I still checked for possible head trauma (LOC + PERL + v/s), just in case - even though I was 99% certain it's going to be AMA since she slept on the same shoulder she fell on.

The elderly are a different ball game. Certainly would have done the same myself. Then again, what you mentioned are things that can be measured in the matter of a few sentences.

 

[Qulevrius]

Very true. It just illustrates to the OP that assessments differ from case to case and there's no such thing as panacea (contrary to what they teach in the EMT class).

 

[gotbeerz001]

The elderly are a different ball game. Certainly would have done the same myself. Then again, what you mentioned are things that can be measured in the matter of a few sentences.

Had a 80+ F with an unwitnessed fall and small cut above the eye from her glasses. Dementia pt but responding better than most; just very stoic. Fire had placed a collar PTA and we were considering transport to her regular facility, but something seemed a bit off. Vitals were stable but SpO2 seemed a little low (93%) though she had no resp distress. Standing back from her a bit, her shoulders looked just a bit asymmetrical; removed the collar to check and found an obvious clavicle fx at the sternum which earned her a ride to the trauma center. Final tally of injuries were L clavicle fx and 3 fxd posterior ribs under her scapula which perforated the apex of her L lung.

Definitely need to do a full check and err on the side of precaution for the elderly.

 

[highglyder]

Had a 80+ F with an unwitnessed fall and small cut above the eye from her glasses. Dementia pt but responding better than most; just very stoic. Fire had placed a collar PTA and we were considering transport to her regular facility, but something seemed a bit off. Vitals were stable but SpO2 seemed a little low (93%) though she had no resp distress. Standing back from her a bit, her shoulders looked just a bit asymmetrical; removed the collar to check and found an obvious clavicle fx at the sternum which earned her a ride to the trauma center. Final tally of injuries were L clavicle fx and 3 fxd posterior ribs under her scapula which perforated the apex of her L lung.

Definitely need to do a full check and err on the side of precaution for the elderly.

Good call on removing the collar. How many types of injuries have been missed because of that damn thing? I think we all agree that local vs general exam has too many variables to give one single answer to those who seek such advice.