What is MTC and what are the main ones on london?
- Major Trauma Centre
- St Mary's
- St George's
- Royal London
HEMS immediate dispatch- 3 minutes
- One under- train
- Fall >2 floors (>20 feet)
- ejected from vehicle
- trapped under vehicle (not motorcycle)
- death of same vehicle occupant
- traumatic amputations above wrist or above ankle
- other emergency service request
HEMS interrogation dispatch- 7 minutes to dispatch
- Fall from height <2 floor
- impaled on an object
- stabbings/ shooting
- burns/ scalds
- industrial accidents
- building site accidents
- hangings drowning
Why is the trauma tree used?
to ensure the patients are appropriately transported to a major trauma centre
What is MOI?
- mechanism of injury
- physical force that is exerted on the body which results in an injury
what percentage of information about MOI do you get from obs and history taking?
- 80% of information from history taking
- 20% of information from obs
what are the types of MOI?
- fall from standing/sitting/height
- abnormal flexion/extension/rotation of joints (whiplash or C-spine)
- blunt trauma (deceleration and compression force)
- penetrating trauma
what are 2 significant mechanisms?
- fall >6m/2 stories in adults or
- fall >3m/2 times height of child
- entrapment (relative and absolute)
What are significant mechanisms with relation to a motor vehicle?
- intrusion >30cm on occupants side
- Ejection from vehicle
- death in same passenger compartment
- motorcycle crash >20mph
- pedestrian/cyclist vs. motor vehicle >20mph
Who should you have special considerations for who have a lower resilience to trauma?
- patient aged >55
- patient's taking anti- coagulants (e.g. warfarin)
- pregnant patients >20 weeks
- patients on dialysis
- burns- full thickness facial/ circumferential or >20%
- paediatrics <12
- your judgement
what speed do airbags go off?
how do you work out kinetic energy?
kinetic energy= 1/2 m x v squared
1/2 70 (kg) x 30 squared (mph)
35 x 900 = 31,500
where does the energy dissipated in car crash?
through crumple zones before passenger compartment
what should you also take into account when it comes to RTC?
- angle of impact
- difference size of vehicles involved
- restraints used (seat belts)
- safety mechanisms deployed (airbags)
what is triage?
- to sort
- categorising patients based on severity
- prioritise care accordingly
what is step 1 of triage sieve?
- shout "if you are injured and able to walk, come towards me"
- these patients cat 3
what is step 2 of triage sieve?
continue to incident site- use triage sieve giving patients an appropriate priority tag
what should be person 1 doing in triage?
- assessing patient
- physiological signs
- catastrophic haemorrhage control
- airway maintenance
what should person 2 be doing in triage?
- stood up collecting data
- putting priority tags on patients
- keep tally of casualties
- maintains safety
- make sure patients aren't missed
- liaises with triage officer
what label would you put on a patient after assessing them?
- priority 1
- priority 2
- priority 3
what is triage sort?
- 2nd stage of triage
- more in depth
- systolic BP
what are the 2 stages of triage?
what tool is there to triage paediatrics?
what height or weight should you triage as an adult?
What is SCENE and when should it be used?
- assessing initial trauma scene
- Cause (MOI)
- Number of patients
- Extra resources needed
what is METHANE and when should it be used?
- provide initial communication and details at a major incident
- Major incident declared
- Exact location
- Type of incident
- Hazards known or potential
- Access and egress for vehicles
- Number of casualties
- Emergency services required
what is a windscreen report?
- press priority on airway radio
- give EOC your call sign and CAD number
- tell them exactly what you see
- follow with a METHANE report
What is ATMIST and when should it be used?
- handover trauma
- Time of incident
- Signs and Symptoms
- Treatment given/immediate needs
what is CATMIST and when should it be used?
- Trauma blue call
- Call sign/CAD
- Time of incident
- Injuries found
- Signs- Vital
- Treatment given
What does SBAR stand for?
- Recommendations, requests and read back
In SBAR, what do you include for situation?
- identify yourself and where you are calling from
- identify the patient that you are calling about
- briefly describe your concern
In SBAR, what do you include for background?
- give the reason for the 999 call
- explain the significant and relevant medical and drug history
- consider the relevant family and social circumstances
In SBAR, what do you include for assessment?
- current vital signs
- describe physical findings on examination
- including pertinent findings
In SBAR, what do you include for rec recommendations, requests and read back?
- explain what you think the patient needs
- make suggestions not demands
- be specific about time frame and patient expectations