Handling Trauma Calls

Taken from Public Communications Magazine February 2005
Written by Bob Smith


Trauma is generally defined as "physical injury caused by an accident or violence." The proper EMS response and pre-arrival instructions for traumatic-incident calls rely heavily on the Emergency Medical Dispatcher's (EMDs) ability to gather several key points of information regarding the nature of the incident, the extent and location of injuries and the identification of priority symptoms.

With trauma calls, the caller typically reports the chief complaint as a mechanism of injury. The mechanism of injury is how the patient received the injury. Examples of this can be reports of a pedestrian struck by a vehicle or a person who has fallen off the roof.

The EMD will assess traumatic-incident calls differently from calls with medical chief complaints. The factors used to determine response levels to traumatic injuries are different from those applied to medical complaints. The primary determining factors in response to traumatic incidents are the mechanism of injury, the location of the injury on the body (central or peripheral, torso or arms and legs) and the presence of any significant critical symptoms.

Significant critical symptoms can include altered levels of consciousness (which can indicate the onset of shock), a head injury, an underlying medical problem, severe hemorrhage or breathing problems associated with injuries to the central core.

Pre-arrival instructions for traumatic incidents vary widely based on the situation and injury. In many cases, they include the same instructions that apply to medical chief complaints, especially in dealing with airway control. However, traumatic incident guidecards include more specific injury-related instructions. These pre-arrival instructions are designed to protect the patient from further injuries caused by well-meaning but untrained bystanders who try to help.

In these cases, pre-arrival instructions primarily address ensuring scene safety for patients, bystanders and responders. Instructions are provided for controlling external bleeding, for ensuring the patient's airway is clear and for advising the caller to do nothing (if that's the most appropriate action). The caller is also directed to guide responding units to the patient and to call back if the patient's condition worsens.

EMDs should suspect spinal-cord injuries if they are given an indication of severe facial or head injuries, unconsciousness, numbness, tingling or loss of sensation in any extremeties, paralysis or an inability to move any extremities, pain in the back upon movement or attempted movement, or any motor dysfunctions.

Some additional considerations exist for dealing with traumatic incidents involving pediatric patients. Traumatic incidents are by far the most common chief complaints in incidents involving children. With regard to CPR and obstructed-airway intervention, children are defined as aged one to eight years. People who are older that that are considered adults for CPR purposes.

Traumatically injured children should not be moved unless in danger. A common error is to move or pick up the child, run into the house or shelter and hold the child to comfort him or her. This can lead to further injuries in patients with spinal injuries. If injured children move on their own, they should be made to lie down on a flat surface and encouraged to remain still until responders arrive. Bystanders should be instructed to keep children calm and reassured until help arrives.

Children can have critical injuries where the symptoms remain hidden until the child reaches a point of rapid deterioration. Critical symptoms such as low blood pressure do not appear as rapidly in children as in adults. Others symptoms like breathing and pulse may be difficult to interpret in a child who is hurt or frightened. If priority symptoms are present, time is critical and the child must be taken for care immediately.

Concsious injured children require extra attention. Callers should reassure and support the child emotionally. This support should be constant and, preferably, come from a single, consistent bystander. This must be communicated through the EMD to the bystanders.

Remember, the emotional condition of the patient and/or the caller should not be considered an indicator of the severity of the problem. Bystanders and children may be distraught from witnessing the incident or from the sight of blood of of limbs bent at unnatural angles. Different people react to emergency situations differently. One person may react calmly and the next hysterically to the same situation. Never allow a caller's emotional status to dictate a response mode. Do not assume the incident is more or less serious than it sounds, based on the caller's reaction.

This is especially true if the caller is a child. Children sometimes cannot grasp the severity of a situation or the grave danger involved. Their lack of experience and knowledge may cause them to be relatively calm, despite the critical nature of a situation.

Prevention is the most powerful treatment for most childhood injuries. EMDs can play a role in injury prevention by recognizing and reporting traffic, playground or other hazards as they are identified in calls relating to childhood injuries.

These are some suggested methods for handling traumatic calls. Refer to your supervisor, your agency's operating guidelines and your APCO Institute EMD Guidecards and MEDS software for assistance and further information.