Priority Action Approach for Trauma Patients

Question 1

Outline the basic framework of the priority action approach

Answer 1

1. Scene Assessment
2. Primary Survey and Critical Interventions
3. Transport Decision
4. Secondary Survey

Question 2

Conduct a scene assessment

Answer 2

1. Introduce yourself
2. What happened? Mechanism of Injury?
3. How many patients?
4. Are there any hazards? Is the scene safe?
5. Activate WERP
6. Take 4 deep breaths and stay calm

Question 3

If the mechanism of injury from the scene assessment suggests that the mechanism of injury is spinal trauma, how would you proceed?

Answer 3

Realign C-spine to anatomical neutral and then conduct primary survey

Question 4

Conduct a primary survey on a patient who is responsive

Answer 4

This applies to both spinal and non-spinal patients
1. Call EHS and notify them that patient meets RTC if you have determined that spinal trauma is indicated
2. Assess AVPU
3. Conduct ABCs
4. Blow, Flow, Show, Know if there are breathing difficulties
5. Conduct SOAPI
6. RBS

Question 5

How would you proceed with a patient who has spinal trauma and is unresponsive?

Answer 5

Jaw thrust, feel for breathing and check carotid pulse

Question 6

Scenario: Patient has spinal trauma and is unresponsive. You find that breathing and carotid pulse are present. How do you proceed in the primary survey?

Answer 6

Insert an OPA and apply a non-rebreather mask with 10 LPM oxygen, then proceed with the primary survey

Question 7

In what case would you need to perform the Show and Know during a primary survey?

Answer 7

If there are signs or symptoms of chest or respiratory injuries/illnesses

Question 8

Scenario: Patient has spinal trauma and is unresponsive. You find is not breathing, but carotid pulse is present. How do you proceed in the primary survey?

Answer 8

1. Attempt to ventilate
2. Check effectiveness of ventilation and train helper
3. Insert OPA
4. Complete primary survey

Question 9

Scenario: Patient has spinal trauma and is unresponsive. You find that breathing and carotid pulse are both NOT present. How do you proceed in the primary survey?

Answer 9

Start CPR/AED immediately
1. Start chest compressions
2. Give 2 breaths with pocket mask in between cycles of 30 chest compressions
3. Train helper on how to perform chest compressions
4. a) If there is another OFA attendant on scene, get them to assist ventilation with BVM
b) Get helper to use pocket mask if no trained attendant is available
5. Start AED - splash test, move away from water, shave chest, remove jewellery
6. Insert OPA and start high-flow oxygen at 15 LPM
7. Continue chest compressions until EHS arrives or pulse returns (check carotid pulse regularly)
7.1. If carotid pulse returns, continue with primary survey
7.2. If patient starts vomiting, put in lateral position and help remove fluids from airway

Question 10

How would you proceed with a patient who has spinal trauma and is unresponsive?

Answer 10

Head-tilt, chin-lift. Feel for breathing and carotid pulse.

Question 11

Scenario: Patient does not have spinal trauma and is unresponsive. You find that breathing and carotid pulse are present. How do you proceed in the primary survey?

Answer 11

Insert an OPA and apply a non-rebreather mask with 10 LPM oxygen, then proceed with the primary survey

Question 12

Scenario: Patient does not have spinal trauma and is unresponsive. You find that the patient is not breathing, but the carotid pulse IS present. Ventilation is not effective.
How do you proceed in the primary survey?

Answer 12

1. Attempt to ventilate - not effective
2. Start CPR/AED

Question 13

Scenario: Patient does not have spinal trauma and is unresponsive. You find that the patient is not breathing, but the carotid pulse IS present. Ventilation is effective.
How do you proceed in the primary survey?

Answer 13

1. Attempt to ventilate
2. Check effectiveness of ventilation and train helper
3. Insert OPA
4. Complete primary survey

Question 14

What determines whether patients require SMR?

Answer 14

If they do not pass the modified NEXUS criteria

Question 15

What are the modified NEXUS Criteria?

Answer 15

If they fail any of the following, they require SMR:
1. Are they fully alert?
2. Signs of intoxication
3. Neck or back pain?
4. Midline cervical discomfort
5. Over 65?
6. Any previous history of spinal injuries
7. Numbness/tingling in extremities
8. Distracting injuries
9. New onset focal neurological deficits
10. Multi-system trauma

Question 16

If, during the Primary Survey, it is determined that the patient is RTC, what must the OFA attendant do

Answer 16

1. Carry out critical interventions for problems with the airway, breathing and circulation
2. Complete the primary survey
3. Apply the Modified NEXUS rule if appropriate
4. Quickly prepare for rapid transport by packaging the patient
5. Reassess the patient’s ABC’s (every 5 mins)
   Steps 1-4 should be completed in less than 15 mins

Question 17

How would you manage a conscious patient with a partial airway obstruction?

Answer 17

1. Conduct scene assessment
2. Notify BC EHS that patient is RTC
3. Assess LOC
4. If there is a traumatic mechanism, manually support the neck, and encourage coughing to clear foreign material from the airway
   5.1. If lying supine, roll patient to lateral or 3/4-prone position to facilitate drainage (use suctioning if necessary)
   5.2. If foreign body is suspected of causing obstruction and the patient is in severe respiratory distress and is standing or sitting, give back blows and abdominal thrusts until the foreign body is expelled or patient loses consciousness
5. If partial airway obstruction persists, assist ventilation if needed, and transport to medical care

Question 18

How would you manage a conscious patient with complete airway obstruction?

Answer 18

1. Conduct scene assessment
2. Notify BC EHS that patient is RTC
3. Assess LOC
4. If patient is standing or sitting, give sequence of up to 5 back blows followed by 5 abdominal or chest thrusts and repeat until foreign body is expelled, the patient starts to breathe or cough, or patient becomes unresponsive
5. If obstruction has not been relieved and patient becomes unresponsive, psotiion the patient supine, update emergency health services, start CPR and request AED
6. Start CPR/AED protocol until airway obstruction is relieved or EHS arrives
7. If patient starts breathing normally and carotid pulse returns, complete primary survey and initiate RTC

Question 19

How would you manage an unresponsive patient with complete airway obstruction?

Answer 19

1. Conduct scene assessment
2. Assess LOC
   Position patient supine as necessary and open airway - assess ABCs
3. If patient is into breathing normally, and carotid pulse is absent, started CPR/AED protocol
4. If obstruction is relieved:
   a) Give 2 breaths + watch chest rise
   b) If patient is not breathing normally, check carotid for 5 seconds, and if it is absent, then assume cardiac arrest and continue CPR/AED
5. If patient starts breathing normally and carotid pulse returns, complete primary survey and initiate RTC

Question 20

What critical interventions would you perform for a patient with facial trauma including angulation of the nose and lacerations to the cheek?

Answer 20

1. Roll patient laterally if blood obstructing airway
2. Use gravity, finger sweep, and suction if indicated (in that order) until bleeding stops
   2.1. If bleeding does not stop, maintain lateral position

Question 21

What critical interventions would you perform for a patient who was unresponsive and had been drowning?

Question 22

What critical interventions would you perform for a patient with a flail chest?

Answer 22

Apply pressure over the site of injury and train a helper to take over

Question 23

What critical interventions would you perform for a patient with an open fracture and bone sticking out?

Answer 23

Manually stabilise the limb with the open fracture by securing it to a stable limb, and control the bleeding with sterile gauze and pads around the fracture

Question 24

What critical interventions would you perform for a patient with a closed fracture of the leg?

Answer 24

Apply pressure on either side of the injury, put a crotch rocket in between the patients leg, and immobilise the unstable leg to the stable leg with quick straps proximal and distal to the injury

Question 25

What critical interventions would you perform for a patient who had been electrocuted with electrical burns to the hands?

Answer 25

Apply a warm, gauze covered with saline to the burn site and get a helper to maintain pressure

Question 26

What critical interventions would you perform for a patient with first degree burns?

Question 27

What critical interventions would you perform for a patient with second degree burns?

Question 28

What critical interventions would you perform for a patient with third degree burns?

Question 29

What critical interventions would you perform for a patient with an open leg wound that was profusely bleeding?

Answer 29

1. Place ABD pads over the bleeding and train a helper to maintain pressure over the wound
2. Wrap 2 triangular bandages on either side of the wound to maintain pressure that cover the entire wound
3. Put a crotch rocket in between legs
4. Immobolise unstable leg with quick straps to stable leg and tie ankles
5. Package patient
   TOURNIQUET

Question 30

What services does BC Emergency Health Services (BC EHS) provide in British Columbia?

Answer 30

BC EHS paramedics in ground and air ambulances, dispathcers, and staff arrange transportation for injured workers to hospitals across B.C.

Question 31

What should the OFA attendant do if rapid transportation to a trauma hospital is in the patient’s best interest?

Answer 31

Inform BC EHS without delay

Question 32

What are non-essential treatments in the context of trauma care, and why should they be avoided?

Answer 32

Non-essential treatments consumer valuable minutes, delaying lifesaving definitive care.

Question 33

What prepartory elements should an OFA attendant’s written procedures include?

Answer 33

• Knowledge of the workplace and work environment
• Quick access to help
• Review of the workplace emergency response plan
• Pre-training workers on assisting in first aid procedures

Question 34

What are some critical interventions included in Rapid Transport Packaging?

Answer 34

1. Airway with C-spine control
2. Ventilation using a pocket mask
3. Provide oxygen
4. Starting CPR and using an AED if necessary
5. Controlling life-threatening hemorrhage
6. Restricting spinal motion and securing the patient to a stretcher

Question 35

What 3 “truths” provide the rationale for the Priority Action Approach?

Answer 35

1. Efficient use of time to transport the patient to the hospital quickly
2. Trauma patients often die because they don’t make it to the operating room in time
3. Major trauma patients cannot be stabilised in the field, requiring only lifesaving critical interventions pre-hospital

Question 36

What are the main mechanisms of injury that require rapid transport to the hospital?

Answer 36

• Free fall from a height greater than 6.5m
• Severe deceleration in a motor vehicle accident
• Severe crush injuries
• Smoke or toxic-gas inhalation
• Electrical injuries

Question 37

What does the primary survey in the Priority Action Approach involve?

Answer 37

A rapid assessment to determine the presence of any life-threatening injuries or conditions, including airway, breathing, and circulation checks

Question 38

What are the key points in communicating with helpers at an accident scene?

Answer 38

• Provide clear and concise directions
• Inform them about the number of patients and the exact location
• Summon medical aid if needed
• Control the scene and bring required equipment

Question 39

How should the OFA attendant handle communication with the patient?

Answer 39

• Be calm and reassuring.
• Use the patient’s name.
• Speak clearly and slowly.
• Explain procedures in advance.
• Be truthful.

Question 40

What is the first step an OFA attendant should take in assessing the airway of a multi-system, head and/or spinal trauma patient?

Answer 40

The OFA attendant should manually stabilise the head and neck, then if the patient is unresponsive, open the airway using the Jaw Thrust manoeuvre and assess air movement in and out of the mouth and nose.

Question 41

What should an OFA attendant do if a trauma patient is not breathing normally or shows signs of agonal breathing, and the carotid pulse is absent or uncertain?

Answer 41

The OFA attendant should initiate CPR/AED according to protocol.

Question 42

When must C-spine control be handed off to a helper during airway management?

Answer 42

Before performing critical airway interventions or completing the primary survey on a patient who is not in cardiac arrest.

Question 43

How should an OFA attendant handle a suspected obstructed or partially obstructed airway in a trauma patient?

Answer 43

The airway must be cleared before proceeding with the primary survey. The jaw thrust manoevre is preferred if head and/or spinal trauma is suspected.

Question 44

What additional steps might be necessary if the jaw thrust does not adequately open the airway during CPR?

Answer 44

It may be necessary to extend the patient’s head and neck, insert an oral airway, and provide assisted ventilation with a pocket mask and oxygen.

Question 45

What are the three breathing states an OFA attendant will assess?

Answer 45

1. Agonal/absent
2. Slow, shallow, inadequate
3. Appropriate rate/rhythm/tidal volume

Question 45

What is the primary concern in the “B for Breathing” step of the primary survey?

Answer 45

To assess the patient’s breathing or respiration to ensure that the body’s organs receive enough life-sustaining oxygen and carbon dioxide is removed.

Question 46

What actions should an OFA attendant take if an unresponsive patient shows signs of agonal respirations and the carotid pulse is absent or uncertain?

Answer 46

Initiate CPR/AED without delay.

Question 47

What signs indicate severe respiratory distress that may require assisted ventilation with oxygen?

Answer 47

Very slow and/or shallow, ineffective respiration with little chest wall movement

• Struggling, labored, gasping respiration
• Use of accessory muscles of respiration
• Patient exhibiting panic and feeling of being smothered

Question 48

What should be done if a patient with respiratory distress resists assisted ventilation despite reassurances?

Answer 48

Stop assisted ventilation with a pocket mask and provide supplemental oxygen using a nasal cannula or a simple oxygen mask placed close to the patient’s breathing zone

Question 49

What is the third and final step in the primary survey of a trauma patient?

Answer 49

Assess circulation for signs of shock, life-threatening bleeding, and obvious fractures

Question 50

What indicates the need to perform a rapid body survey (RBS) during the primary survey?

Answer 50

To detect critical emergencies such as life-threatening external hemorrhage, hidden massive hemorrhage, obvious fractures, and to ask about neurological deficits

Question 50

What should an OFA attendant do if the radial pulse is absent but the carotid pulse is present and breathing is not effective?

Answer 50

Assisted ventilation using a pocket mask with oxygen is required.

Question 51

What is the frequency of ABC reassessment for RTC and non-RTC patients?

Answer 51

Every 5 mins for RTC patients
Every 10 mins for non-RTC patients
Every 5 mins for urban OFA attendants with a patient requiring transport with BC EHS resources

Question 52

What anatomical injuries are considered severe enough to require rapid transport?

Answer 52

Severe brain injury, defined as one or more of the following:
- Glasgow Coma Score of 13 or less
- Pupillary inequality greater than 1 mm and sluggish response to light with altered level of consciousness
- Depressed skull fracture

Question 52

Why is frequent reassessment of the ABCs crucial even if the patient appears stable initially?

Answer 52

Because the patient’s condition can deteriorate quickly, necessitating a change to the Rapid Transport Category and updating BC EHS regarding the patient’s condition.

Question 53

What steps should be taken during patient packaging for rapid transport?

Answer 53

1. Carry out critical interventions for problems with airway, breathing, and circulation
2. Complete primary survey
3. Apply the Modified NEXUS Rule (when appropriate)
4. Quickly prepare for rapid transport by packaging the patient
5. Reassess the patient’s ABC’s

Question 54

What equipment is required for rapid transport packaging?

Answer 54

1. A hard cervical collar of the appropriate size
2. A long spine board (may be needed for extraction)
3. A scoop-style stretcher with securing straps
4. A well-padded patient care transport stretcher
5. Straps (adequate number of 2m x 5cm heavy Velcro straps, spider straps, or safety-belt-type straps with quick release buckles)
6. An adequate number of regular blankets or comparable padding

Question 55

Why should the head and neck be secured last when packaging a suspected spinal-injured patient?

Answer 55

To avoid additional injury to the neck and head if there are any inadvertent movements before packaging is complete. This makes it easier to protect the head and neck and maintain alignment with the body.

Question 56

What are the advantages of rapid transport patient packaging?
A:

Answer 56

1. The patient is rapidly prepared for transport
2. It is easier to manage the patient’s airway while protecting his or her cervical spine
3. Provides some chest-wall stabilisation for associated chest injuries
4. Other injuries are effectively secured, reducing aggravation (eg. spinal injuries, pelvic fractures, lower-limb fractures)
5. The patient is protected from further injury en route
6. The delirious or combative patient is effectively controlled

Question 57

What is the primary focus when packaging a patient for rapid transport?

Answer 57

Reducing scene time and ensuring precious minutes are used only for necessary actions. Conduct necessary critical interventions and get the patient packaged and en route to medical aid as quickly as practicable.

Question 58

What should be done if new important information is found after the initial call to BC EHS?

Answer 58

Contact BC EHS again to provide an update

Question 59

When should the secondary survey be conducted for a patient in the Rapid Transport Category?

Answer 59

En route to the hospital or;
If transport is not readily available, after packaging the patient while awaiting transportation

Question 60

What is the pulse and why is it important in first aid?

Answer 60

The pulse is an indicator of the status of the circulation, showing heart rate and strength of blood flow, which is crucial in assessing blood loss and overall cardiovascular health.

Question 61

How does the body respond to blood loss regarding pulse?

Answer 61

The heart pumps faster to improve blood output, speeding up the pulse. As blood loss continues, blood is diverted from non-critical areas to vital organs, making the radial pulse weak and the carotid and femoral pulses relatively stronger.

Question 62

Why is pulse assessment more important than blood pressure in a primary survey?

Answer 62

Because the strength, rate, and regularity of the pulse provide immediate insight into the patient’s circulatory status, especially the radial and carotid pulses.

Question 63

How do you measure the pulse rate manually

Answer 63

Count the number of beats in a 15-second interval and multiply by 4 to gets beats per minute. This should match the rate calculated by a pulse oximeter.

Question 64

When is it important to detect pulse irregularities?

Answer 64

n cardiac or respiratory emergencies. For trauma patients, prioritize rapid medical intervention unless already en route to medical aid.

Question 65

What is the Glasgow Coma Scale (GCS)?

Answer 65

A scoring system to measure the level of consciousness based on eye-opening, verbal, and motor responses, ranging from 3 (lowest) to 15 (highest).

Question 66

How is the eye-opening response scored in GCS?

Answer 66

Spontaneous: 4
To verbal command: 3
To painful stimulus: 2
No response: 1

Question 67

How is the verbal response scored in GCS?

Answer 67

Clear and coherent speech: 5
Confused speech: 4
Inappropriate words: 3
Incomprehensible sounds: 2
No response: 1

Question 68

How is the motor response scored in GCS?

Answer 68

Follows commands: 6
Localizes pain: 5
Withdraws from pain: 4
Decorticate posturing: 3
Decerebrate posturing: 2
No response: 1

Question 69

What do pupil reactions indicate in a head injury?

Answer 69

Normally, pupils constrict in light and dilate in darkness. Unequal, dilated, or non-reactive pupils suggest serious head injury and decreased consciousness

Question 70

What does pale or cyanotic skin indicate

Answer 70

ale skin indicates blood loss and possible shock. Cyanosis (bluish skin) indicates low oxygen levels and a cardiorespiratory emergency.

Question 71

What does cool skin temperature indicate in trauma patients?

Answer 71

It can be an early sign of shock as blood vessels constrict to preserve blood flow to vital organs, making extremities feel cool

Question 72

What is the significance of moist or sweating skin in trauma patients?

Answer 72

Moist or sweaty skin can be an early sign of hypovolemic shock, indicating significant blood loss and the body’s stress response.

Question 73

How often should vital signs be reassessed for RTC and non-RTC patients?

Answer 73

RTC patients: every 10 minutes
Non-RTC patients: every 30 minutes

Question 74

What is the mnemonic for taking history of a patient’s pain?

Answer 74

PPQRRST or P2QR2ST, which stands for Position, Provoke, Quality, Radiation, Relief, Severity, and Timing.

Question 75

What allergy information is important to document?

Answer 75

Any previous allergic reactions to drugs, chemicals, foods, or pollens, and whether medical attention was required.

Question 76

What details about current medications should be documented?

Answer 76

6 R’s of medication
Name, dose, frequency, purpose, compliance, and expiry date.

Question 77

What is the purpose and steps for history taking in first aid?

Answer 77

Purpose: Gather information about past medical history and current complaints.

Steps:
- Ask about other medical conditions (e.g., diabetes, heart disease).
- Inquire about past illnesses related to the complaint (e.g., previous disc herniation in back injury).
- Ask about previous hospitalizations or surgeries.

Question 78

What is the basic purpose and steps for a Head-to-Toe Examination in the secondary survey?

Answer 78

Purpose: Systematic inspection and palpation to identify injuries or abnormalities.

Steps:
- Start with inspection and palpation from head to extremities.
- Methodical approach: head, neck, chest/abdomen/pelvis, back, extremities.
- Focus on injuries not initially visible, like hidden sharp objects.

Question 79

Describe the Head-to-Toe examination in detail for the secondary survey

Answer 79

1. Head Examination

Steps:
a) Check head and face for wounds, swelling, or deformities.
b) Inspect nose and oral cavity for bleeding or broken teeth.
c) Assess eyes for vision quality and pupils.
d) Palpate facial bones and scalp for tenderness or deformity.
e) Examine ears for hearing aids, fluid leakage, or bruising.

2. Neck Examination

Steps:
a) Inspect for swelling, deformity, or wounds.
b) Check for airway obstruction signs (hoarseness, stridor).
c) Avoid probing open wounds; control bleeding with direct pressure.
d) Assess neck motion carefully for pain or tenderness.

3. Chest, Abdomen, and Pelvis Examination

Steps:
a) Look for bruising, wounds, and palpate for tenderness.
b) Observe chest wall motion for pain, flail chest, or pneumothorax.
c) Palpate abdomen sides for tenderness or signs of internal bleeding.
d) Check bony pelvis stability and tenderness.

4. Back Examination

Steps:
Often overlooked; examine during patient transfer or roll.
a) Check for wounds, tenderness, or deformity.
b) Fully expose and assess if abnormalities found.

5. Extremities Examination

Steps:
a) Inspect for trauma signs (lacerations, swelling, deformity).
b) Palpate for fractures or pain.
c) Assess distal pulses (radial for upper, dorsalis pedis/posterior tibialis for lower).
d) Check capillary refill and skin temperature for circulation assessment.

Question 80

Describe the Neurological examination in the secondary survey

Answer 80

1. Assess level of consciousness using Glasgow Coma Scale (GCS).
2. Examine pupil response to light.
3. Test sensory and motor function in face and limbs.
4. Document findings and changes over time.

Question 81

Describe the assessment for spinal injury in the second survey

Answer 81

1. Apply Modified NEXUS Rule if cervical spine injury is suspected.
2. Assess for midline cervical pain, neurological deficits, and other risk factors.
3. Consider spinal motion restriction based on findings.

Question 82

Describe the Head-to-Toe reassessment

Answer 82

1. Reassess injuries and treatment effectiveness.
2. Monitor dressings, splints, and neurological status.
3. Repeat every 30 minutes during transport or as needed

Question 83

Summarise the priority actions in the secondary survey

Answer 83

• Recap vital signs, history, and examination findings.
• Prioritize treatment based on injury severity.
• Maintain frequent monitoring during transport.

Question 84

Describe the steps of the secondary survey for a non-responsive, trauma patient

Answer 84

1. Conduct neurological examination for LOC and GCS screening
2. Record vitals (respiratory status, SPO2, Pulse, Pupils =/+, Skin)
3. Perform critical interventions if any additional found
4. Monitor vitals and ABCs, assessing them regularly
5. Perform head-to-toe examination and report findings
6. Perform additional neurological testing as indicated
7. Fill out Patient Assessment report

Question 85

Describe the steps of the secondary survey for a responsive, trauma patient

Answer 85

1. Conduct neurological examination for LOC and GCS screening
2. Question patient about chief complaint(s) and PPQRRST if possible
3. Question patient about allergies, medications, and medical history if possible
4. Record vitals (respiratory status, SPO2, Pulse, Pupils =/+, Skin)
5. Perform critical interventions if any additional found
6. Monitor vitals and ABCs, assessing them regularly
7. Perform head-to-toe examination and report findings
8. Perform additional neurological testing as indicated
9. Fill out Patient Assessment report

Question 86

Describe the steps of the secondary survey for a non-responsive, medical patient

Answer 86

1. Conduct neurological examination for LOC and GCS screening
2. Question patient about chief complaint(s) and PPQRRST if possible
3. Question patient about allergies, medications, and medical history if possible
4. Record vitals (respiratory status, SPO2, Pulse, Pupils =/+, Skin)
5. Perform critical interventions if any additional found
6. Monitor vitals and ABCs, assessing them regularly
7. Perform head-to-toe examination and report findings, as neccessary
8. Perform additional neurological testing as indicated
9. Fill out Patient Assessment report