MULTIPLE SYSTEMS TRAUMA / STABLE
(If unstable, see Shock Protocols)

DESIGNATION OF CONDITION

Major trauma involving two or more body systems often cannot be stabilized or well managed in the field and requires prompt surgical intervention. Scene times should be kept to a minimum.  Always assess the mechanism of injury.  Generally, on scene field measures should be limited to the initial assessment, rapid trauma assessment, BLS, CPR, rapid extrication if indicated, placement of a cervical collar as indicated, placement on a long board as indicated, airway management, and chest injury management.

EMPHASIS ON PATIENT CARE

Control of hemorrhage, management of airway, inspection and management of C-spine, minimize scene time.

FIRST RESPONDER AND BASIC PRE-HOSPITAL MANAGEMENT

1. Initial Management - Assess airway, breathing and circulation and manage as indicated.
2. Initiate transport to appropriate medical facility. MUST HAVE ORDERS FROM ON-LINE MEDICAL CONTROL FOR FIELD AIR EVAC.
3. Focused H&P - History, physical exam, vital signs.

INTERMEDIATE and PARAMEDIC PRE-HOSPITAL MANAGEMENT

4. En-route, initiate one or two large bore IVs of an isotonic solution and infuse at a flow rate to maintain adequate vital signs.
5. Utilize a Buretrol in pediatrics at rate of 20 cc/kg. If unable to initiate a peripheral IV, consider intraosseous access if patient condition warrants.