Trauma
Scene size-up and primary assessment
Mechanism of injury predicts the injuries you should look for. Ensure scene safety, use standard precautions, and determine the number of patients. Then perform a primary assessment: catastrophic bleeding, airway, breathing, circulation, and a rapid neurologic check. In trauma, major external hemorrhage is controlled immediately-do not wait until after the full ABC sequence if blood loss is life-threatening.
Bleeding control
Direct pressure with a gloved hand and gauze is first-line. If bleeding is not controlled, use a tourniquet for life-threatening extremity bleeding; place it high and tight, note the time, and do not loosen it in the field. Pack and apply pressure to a bleeding wound on the neck, groin, or other junctional area. Do not remove an impaled object-stabilize it in place.
Shock
Hypoperfusion after trauma means internal or external bleeding until proven otherwise. Signs include a rapid weak pulse, pale cool clammy skin, altered mental status, and thirst. Keep the patient warm, lay them flat, and transport rapidly; do not give anything by mouth.
Specific injuries
Splint suspected fractures in the position found and check distal circulation, sensation, and movement before and after. For burns, stop the burning process, remove smoldering clothing and jewelry (but not adherent material), and cover with a dry sterile dressing. Treat a suspected spine injury with manual motion restriction and a device only when indicated by mechanism and findings.
Traps
Do not move a trauma patient before controlling bleeding and airway; do not assume a normal-looking limb excludes fracture; and do not delay transport just to splint.
Rule of thumb
Trauma priorities are catastrophic bleeding, airway, breathing, circulation, disability, and transport-in that order.