Major trauma is when the patient has an ABCD compromise that has been induced by the trauma that is an abnormality in ABCD with an indicative mechanism of injury (a MOI that explains the findings.) Mechanism can give you a general idea of the current situation, but it is not enough alone. 

Any abnormality in D is considered to be an indicator of major trauma except for motor or sensory deficits. Some examples of major trauma are abdominal trauma, burns, electrocution, limb trauma, neck and back trauma, pelvic trauma, immersion incident, thoracic trauma, trauma in pregnancy, and head trauma.

1st priority: Collier + Spine Board + Hooks 

2nd Priority: Collier + Scoop + Matelas

If we want to logroll a patient wearing a helmet, we remove the helmet before the logroll.

If our pneumothorax patient with a valve on advances to tension pneumothorax, we release the pressure, and then we seal it again.

For tension pneumothorax patients, we do not perform assisted ventilation, but we do perform artificial ventilation and give normal breaths during CPR.

If we want to place a head padding (rembourage) on the scoop, we can use the spine head support materials.

The coccygeal area is considered as part of the spine, therefore, when signs of trauma (pain, deformity,..) are present in this area, full immobilization must be effected.

When we want to logroll a patient, we do it on the uninjured side by paying attention not to move the injury a lot.

In case we cannot logroll on the injured side (ex: space management issues), we CAN logroll on the injured side.

When we want to logroll a patient, we do it on the uninjured side by paying attention not to move the injury a lot.

In case we cannot logroll on the injured side (ex: space management issues), we CAN logroll on the injured side.

Any patient suffering from trauma to the hip must be immobilized with the scoop and mattress (matelas) as soon as possible. Contraindications include being seated on any chair while transporting to the ambulance.

We should deflate the mattress a bit before placing the patient.

When only one sling (foulard) is available before the application of a pelvic belt, it is preferentially placed above the knees and not at the ankles (8 knot)

No, in critical cases, we don’t splint extremities (crush, open, dislocated,...) unless we have enough resources

Transporting any fully immobilized patient from our stretcher to the hospital's stretcher must be done using only a scoop or spine board.

"Hemodynamic compromise" refers to a condition in which the blood flow and circulation within the body are inadequate to meet the physiological needs of tissues and organs. This can lead to insufficient oxygen delivery, resulting in symptoms such as low blood pressure, organ dysfunction, or shock. It typically occurs due to factors like severe blood loss, heart problems, or fluid imbalances. Prompt medical attention is often required to restore adequate blood flow.

Signs of hemodynamic compromise = signs of shock (no need to check for PB)

When divided into 2; the first half of the scoop must be placed under the unaffected (good) side/extremity before the placement of the second half under the affected side.

In case of a neck wound, place an occlusive dressing on the neck wound, and close ALL 4 SIDES, and then, apply a compressive bandage on the dressing to avoid the development of an air embolism in the patient. 

For patients with broken ribs requiring immobilization, we use Spine and Hooks materials and add chest paddings.

If the Jaw Thrust maneuver isn't functioning, you will need to perform the Chin lift maneuver without the HEAD TILT

You can add a collar for a patient with crepitus in the jaw, but if the patient experiences pain after its insertion, remove it and immobilize without the collar.

We immobilize the patient with an unstable pelvic using SCOOP + MATTRESS.

Indications for applying a pelvic belt include the presence of the following:

• Signs of pelvic injury (pain, open book....) 

• Signs of hemodynamic compromise

• Indicative MOI (an MOI that justifies the presence of the pelvic fracture)

General notes: 

• Be careful and avoid excessive movement when applying a pelvic belt.

• Use a scoop stretcher with a vacuum mattress to lift the patient.

• You are allowed to use the pelvic belt on any suspected pelvic fracture or injury, even if it’s not an open book fracture.

• It’s not contraindicated to apply the pelvic belt on pregnant women or children.

In cases of allergic reactions:

Administer EpiPen: Moderate, severe, and anaphylactic shock

High flow NRB: Severe and anaphylactic shock

If PB > 180mmHg, we consider the case critical.

If the patient is responsive and can swallow, we should administer approximately 15-25g of oral glucose.

• 2 tablespoons or 3 to 4 packets of table sugar dissolved in water

• 3/4 cup to 1 cup of juice or regular soft drink

• 15-25 ml (1.5 to 2 tablespoons) of honey or jam

NB: I NEVER ADMINISTER SUGAR TO AN UNCONSCIOUS PATIENT!!!

Begin with a low flow rate of oxygen (e.g., 1-2 liters per minute via nasal cannula) and gradually increase based on the patient's needs and response.

Conversely, "Titrating down" for oxygen involves the gradual reduction of the oxygen flow rate or concentration given to a patient. This adjustment occurs when the patient's condition has stabilized, and their oxygen saturation levels are within the target range, suggesting decreased necessity for high levels of supplemental oxygen.

ADULTS

Provide continuous rescue breaths every 5-6 seconds (10-12 breaths/min) for 2 minutes before reassessing.

Breath, 2, 3, 4, 1 .... Breath, 2, 3, 4, 2 .... Breath, 2,

CHILDREN

Provide continuous rescue breaths every 4-5 seconds (12-20 breaths/min) for 2 minutes before reassessing.

Breath, 2, 3, 1 .... Breath, 2, 3, 2 .... Breath 2, 3, 15

Infants

Provide continuous rescue breaths every 3-4 seconds (12-20 breaths/min) for 2 minutes before reassessing.

Breath, 2, 1 .... Breath, 2, 2 .... Breath, 2, 20

All the EMTS, within an ambulance, are obligated to sit in the back en route to the hospital when transporting an unstable patient, especially in a CPR emergency.

When we are done with the 3 cycles in CPR, During Transportation we count 90 seconds, then we do a cycle, then we count 90 seconds again... until we arrive to the ambulance.

Remove the patient from the water and move them to a dry area. Quickly check for pulse and breathing for 10 seconds (Quick Look). If there is no pulse, open the airway using suction or finger sweep and then insert an OPA (Unless an OPA is unavailable or too far away, we give two rescue breaths without OPA so that it will not cause a delay). Administer 2 rescue breaths, with each breath lasting about 1 second. After the breaths, check for a pulse again. If there is still no pulse, start the BLSD protocol.

Begin using the suctioning technique to remove liquids while retaining the OPA. 

For a patient who goes into cardiac arrest en route to the hospital, the ambulance is stopped and turned off, in a safe area, once the AED patches are applied and the AED is ready to analyze.

Once analysis is complete; shock administered or not, CPR is continued in the normal way and the ambulance continues its path towards the hospital.

When the 120-compression count is reached again, the driver stops the car again, for the team to get ready for the next analysis.

The process is continued in this manner until the team arrives at the hospital.

Yes, I immediately initiate compression and communicate with the HOS and OR. They will inform me whether to halt CPR or not.

• CPR is indicated when pulse and respirations are absent or when respirations are absent and the pulse is BELOW 60, WITH signs of poor perfusion (cold skin, pallor, delayed CRT...) 

However, if respirations are absent and pulse is BELOW 60, but no signs of poor perfusion are present, we administer 1 cycle of artificial ventilations and then reassess. 

• In case of the presence of 1 EMT who should perform chest, compressions and give rescue breaths: The rhythm goes by a ratio of 30 compressions to 2 rescue breaths

In the case of the presence of 2 EMTs:

EMT 1 performs 15 compressions while EMT 2 administers 2 rescue breaths afterward

• PELVIC TRAUMA (WHICH POSSIBLY LEADS TO INTERNAL BLEEDING)

Never delay compressions in this case. 

If the pelvic belt was applied, it is ideal; however, it should not be applied when there is a chance of

delaying instant compressions upon recognizing pulseless activity in the patient

• EXTERNAL BLEEDING

External bleeding must be managed before initiating chest compressions or even analysis with the AED