STANDING ORDERS - ADULT & PEDIATRIC: :

• Routine Patient Care
• Perform advanced spinal assessment (See Advanced Spinal Assessment Procedure 6.0) to determine if the patient requires spinal motion restriction.
• During the primary survey, providers should follow the MARCH algorithm, continually reassessing patient status:
• M: Massive Hemorrhage: control of life-threatening bleeding is key in traumatic injury, see Shock Protocol - Adult (56 Medical) & Shock Protocol - Pediatric (60 Medical), Tourniquet & Hemostatic Agent Procedure - Adult & Pediatric (65 Medical). if suspected pelvic instability, immobilize your patient according to training.
• A: Airway Control: if the patient is unable to maintain their own airway, insert an adjunct or advanced airway (See Advance Airway Management Procedure, Airway Management Protocol Adult & Pediatric).
• R: Respiratory Support: ensure adequate ventilatory status is attained and SpO2 is kept above 94% using a bag valve mask or other appropriate ventilatory assistance.
• C: Circulation: assess adequate circulation and perfusion, and treat for shock (See Shock Protocol - Adult & Shock Protocol Pediatric).
• H: Hypothermia: ensure the patient is kept warm during transport and shock treatment through the use of bulky blankets, warmed IV fluids, and active warming as indicated.

Obtain baseline vital signs and level of consciousness (A/V/P/U):

EMT/AEMT/PARAMEDIC Standing Orders - ADULT & PEDIATRIC

• Routine patient care. Complete detailed secondary assessment. Treat disability: splint any suspected fractures, consider pelvic binding and treatment of any hemorrhage, evaluate for presence of traumatic brain injury.
• Transport to appropriate destination using Trauma Triage & Transport Decision Policy (5 Triage).
• Continually reassess for changes in patient status.

EMT Standing Orders - ADULT & PEDIATRIC:

• Routine Patient Care.
• Treat disability: splint any suspected fractures, consider pelvic binding and treatment of any hemorrhage, evaluate for presence of traumatic brain injury.
• Consider treatment for hypothermia in shock management
• Limit scene time to < 10minutes; provide early notification to receiving facility.
• Rapidly transport to appropriate destination using Trauma Triage & Transport Decision Policy.
• Call for AEMT/Paramedic intercept. & Assisst AEMT/Parmedic in patient care.

AEMT/ PARAMEDIC Standing Orders - ADULT & PEDIATRIC:

• Obtain IV/IO access
• Consider administration of warmed 0.9% normal saline bolus to treat hypovolemic shock: o Adult: 500 mL bolus to maintain a MAP > 65 mmHg (systolic > 90 mmHg)
  • Pediatric: 20 mL/kg bolus to improve clinical condition (capillary refill time ≤ 2 seconds, equal peripheral and distal pulses, improved mental status, normal breathing).
  • Total volume administered should not exceed 2,000 mL for adults, and 60 mL/kg for pediatric patients.
• See Shock Protocol - Adult (56 Medical) or Shock Protocol - Pediatric (60 Medical).
• Consider an antiemetic for nausea/vomiting
• Consider chest decompression if tension pneumothorax is present. (See Needle Decompression Thorocostomy (NDT) Procedure (25 Skills))
• Consider use of TXA if significant hemorrhage is present. (See Tranexamic Acid (TXA) Protocol - Adult (18 Trauma)). Consider pain management (see Pain Management Protocol - Adult (41 Medical).)
• If MAP remains < 65 mmHg following fluid administration, consider use of vasopressors (see Shock Protocol - Adult (56 Medical)) or Shock Protocol - Pediatric (60 Medical)
• Perform point-of-care ultrasound E-FAST exam if available and credentialed.

Notify the receiving hospital as soon as reasonably possible for patients that meet “Trauma Alert” criteria

PEARLS:

• Scene time should not be delayed for procedures and interventions which can be performed en route.
• BVM ventilation is an acceptable method of airway management if pulse oximetry can be maintained above 94%.
• Rapid transport destination determination and notification of the receiving facility in the event of a “Trauma Alert” are critical for severely-injured patients.
• Geriatric patients should be evaluated with a high index of suspicion, as age related factors may reduce their ability to sense pain, and their ability to compensate effectively in traumatic injury.
• Mechanism is the most reliable indicator of serious injury in many settings.
• TXA in multi-system trauma must be given within 3 hours of injury. Rapid bolus administration of TXA can cause hypotension, so care should be taken in administration.