Trauma Medicine is surprisingly simple, but it’s far from easy. Since this is a stressful, life-or-death struggle, it’s easy to become overwhelmed. If you have never been faced by a situation like trauma, deciding on what to do first is the hardest thing to overcome. I’ve found that breaking down an emergency into easily manageable steps is a good way to prevent the confusion that follows when attempting to stabilize a casualty.
Now obviously this is not a perfect example of set-in-stone procedures. Emergencies are dynamic, constantly changing, and have multiple moving parts and their own sets of challenges, so these won’t work for every situation you encounter. But, if you understand how to accomplish the following steps, you can do a lot of good for someone who is counting on you.
Step 1: Call 911.
This is the first and perhaps most important step. You need as much help as you get, and you need it fast. The quicker the casualty can get to the hospital the more likely it will be they survive. Even a trauma surgeon would be hard pressed to do much more than an EMT when they don’t have all the resources of a hospital at their disposal. So, call 911 and get an ambulance at the scene at your first opportunity so they can whisk the casualty to the ER.
Step 2: Is the scene safe?
Make sure the scene is safe. For you first, then for the casualty. Stop and think about the situation, what your course of action should be, and if you have anyone to help you with the rescue. Take a deep breath then act efficiently, decisively, and confidently because even though this is a tough situation, it’s not impossible to handle.
This is a very important step because if you need to be rescued after trying to save someone else, you’ve just made the problem twice as difficult. You have done nothing to improve the situation and both you and the person you were trying to save would have been better off if you had done nothing at all.
Try to think if there is a way for you to make the scene safe? Can we shut off electricity to the house? Or put out the fire in the car? If nothing can be done to make the scene safe, can we drag the casualty to a location that is safe?
If there is anything that can be done to improve our chances for success, we should try to do it be for proceeding.
Step 3: Control major bleeding.
Act fast to stop arterial blood loss. Apply a tourniquet high on the limb and turn the windlass until the bleeding stops. If you don’t have a tourniquet, the best you can do is apply direct pressure to the wound and try to stem the flow of blood. Just put the heel of your hand against the wound and press down. You might need to get your weight into it to stop the blood flow depending on the casualty and the wound.
Heavy bleeding in the armpits, groin, and neck should be treated by packing the wounds as tightly as you can with Quick Clot Gauze and a pressure dressing. Then apply direct pressure for at least 3 minutes. If blood starts to soak through the bandage, or you don’t have medical gear, apply direct pressure over the wound, and don’t let up until medics arrive and actually instruct you to move out of the way.
Step 4: Manage the casualty’s airway if needed or possible.
They need a clear path for oxygen to enter. The easiest way to evaluate this, is by talking to your casualty. This also helps you know if they’re in danger if they don’t respond correctly, or at all. An example of managing their airway might be to roll the casualty over on their side if vomiting to help them avoid choking.
Step 5: Make it as easy as possible for the casualty to breath.
To do this you may need to apply a seal over a sucking chest wound. Wipe the area clear of any blood and apply the seal directly over the wound. Make sure to look for an exit wound as well. Whatever the injury, try to position the casualty in a way that allows them to breath the easiest. If the casualty is conscious, they will do this on their own. Breathing is important and they’ll try to sit or stand in a way that makes it easier. Let them if there is no special risk that would put them in further danger.
Step 6: Recheck and reassess.
Our casualties are medically unstable, so we need to be reevaluating them every chance we get to make sure they aren’t getting worse. This step is where we recheck the casualty more thoroughly to ensure we haven’t missed anything dangerous, and make sure the tourniquets, chest seals, and pressure dressings are doing their job.
Step 7: Keep the casualty warm.
If you think they might be in shock because of cool, clammy skin and they are not responding to your questions correctly, or at all, cover them with blankets to keep them from becoming hypothermic.
The Wrap Up
If you understand how to accomplish each of these steps, there’s a good chance you can keep a casualty stable until paramedics can arrive on scene. We will be going over each of these steps in detail in further blog posts, so if you don’t know how to do these things, don’t worry, we’ll get you there.