Unit 4: Patient Treatment and Transport
Trauma Emergencies
From motor vehicle collisions to falls and penetrating injuries, trauma patients can have serious injuries that are not immediately visible. EMTs must recognize potentially life-threatening conditions, provide appropriate emergency care, and determine when rapid transport is necessary. This NREMT study guide lesson covers trauma assessment, head and spinal injuries, chest and abdominal trauma, fractures, burns, and multisystem trauma. Five EMT practice questions with detailed explanations will help reinforce these important concepts.
Trauma refers to physical injuries caused by external forces. These injuries may affect a single body region or multiple organ systems.
EMTs must identify life-threatening injuries, support airway and breathing, control severe bleeding, and arrange appropriate transport.
Types of Traumatic Injuries
Traumatic injuries are generally classified as blunt or penetrating.
Blunt Trauma
Blunt trauma occurs when physical force injures the body without an object penetrating the skin.
Common causes include motor vehicle collisions, falls, sports injuries, and impacts from objects.
Blunt trauma can cause fractures, internal bleeding, and organ damage, even when few external injuries are visible.
Penetrating Trauma
Penetrating trauma occurs when an object pierces the skin and enters the body.
Examples include gunshot wounds, stab wounds, and injuries involving sharp objects. These injuries can damage internal organs and blood vessels, causing life-threatening bleeding.
Trauma Assessment
EMTs should consider the mechanism of injury (MOI) when evaluating trauma patients.
The MOI describes how an injury occurred and the forces involved. A high-speed collision, significant fall, or penetrating injury may suggest serious trauma.
After addressing immediate life threats, assess for:
- Deformities, swelling, and tenderness.
- Bleeding or open wounds.
- Abnormal chest movement.
- Changes in mental status.
- Signs of poor circulation.
A systematic head-to-toe examination may be necessary for patients with significant trauma, particularly when they cannot reliably describe their injuries.
Head Injuries
Head injuries range from mild concussions to severe traumatic brain injuries (TBIs).
Warning signs of serious head injury include:
- Loss of consciousness or confusion.
- Severe or worsening headache.
- Repeated vomiting.
- Unequal pupils.
- Seizures or abnormal breathing.
- Weakness or changes in sensation.
A patient may initially appear alert but deteriorate as bleeding or swelling develops within the skull.
EMTs should monitor mental status, maintain adequate oxygenation and ventilation, and minimize unnecessary movement.
Avoid hypoxia and hypotension in patients with suspected traumatic brain injury, as both can worsen brain damage.
Spinal Injuries
Spinal injuries may result from motor vehicle collisions, falls, diving accidents, and other traumatic events.
Signs may include:
- Neck or back pain.
- Midline spinal tenderness.
- Numbness or tingling.
- Weakness or paralysis.
When a spinal injury is suspected, minimize unnecessary movement and maintain appropriate alignment.
Spinal motion restriction (SMR) may involve manual stabilization, a cervical collar, and securing the patient appropriately on an ambulance stretcher.
Long backboards may be used for extrication or patient movement, but routine transport on a backboard is not necessary for every trauma patient.
Follow local EMS protocols when determining the appropriate precautions.
Chest Injuries
Chest trauma can interfere with breathing and circulation.
Rib Fractures: Broken ribs may cause localized pain, tenderness, and difficulty breathing.
Flail Chest: Occurs when multiple adjacent ribs are fractured, creating an unstable section of the chest wall. Paradoxical chest movement may be present.
Pneumothorax: Air accumulates between the lung and chest wall, potentially causing lung collapse. Signs may include chest pain, difficulty breathing, and diminished breath sounds on the affected side.
Tension Pneumothorax: A life-threatening condition in which increasing pressure within the chest interferes with breathing and circulation. Signs may include severe respiratory distress, markedly diminished breath sounds on one side, and shock.
EMTs should support breathing, request Advanced Life Support (ALS) when appropriate, and arrange rapid transport.
For open chest wounds, follow local protocols for wound management, including a vented chest seal when indicated. Monitor for worsening respiratory distress.
Abdominal and Pelvic Injuries
Abdominal trauma may damage internal organs and cause significant internal bleeding.
Possible findings include:
- Abdominal pain or tenderness.
- Distention or rigidity.
- Bruising.
- Signs of shock.
Pelvic fractures can also cause severe internal bleeding.
When pelvic injury is suspected, minimize unnecessary movement and avoid repeatedly manipulating the pelvis. A pelvic binder may be indicated under local protocols.
Serious internal bleeding requires prompt transport, because EMTs generally cannot control it directly in the field.
Extremity Injuries and Fractures
Extremity injuries include fractures, dislocations, sprains, and strains.
A fracture is a broken bone and may be classified as:
- Closed: The skin over the fracture remains intact.
- Open: A wound communicates with the fracture.
Common signs include pain, swelling, deformity, tenderness, and decreased movement.
When treating a suspected fracture:
- Control significant bleeding.
- Assess circulation, sensation, and movement beyond the injury.
- Cover open wounds with an appropriate dressing.
- Splint the injured area when indicated and when doing so will not delay critical transport.
- Reassess circulation, sensation, and movement after splinting.
Do not force an injured extremity into position. Follow local protocols when circulation is compromised or realignment is necessary.
Burns
Burns may result from heat, chemicals, electricity, or radiation.
Thermal burns are classified by depth.
| Burn Depth | Common Findings |
| Superficial | Red, painful skin without blisters |
| Partial-thickness | Blistering, swelling, and pain |
| Full-thickness | White, brown, or charred skin; sensation may be reduced in the deepest area |
Burn severity depends on depth, location, body surface area affected, and associated injuries.
Burns involving the face, airway, hands, feet, major joints, or genital area may require specialized care.
For thermal burns:
- Stop the burning process and ensure scene safety.
- Cool smaller burns with clean, cool running water when appropriate.
- Remove jewelry and clothing that is not stuck to the skin.
- Cover the burn with an appropriate clean dressing.
- Prevent hypothermia, especially with extensive burns.
Do not apply ice directly to burns or remove clothing stuck to burned skin.
Significant burns and suspected inhalation injuries require prompt transport.
Multisystem Trauma
Multisystem trauma involves significant injuries affecting more than one body system.
For example, a high-speed collision may cause chest injuries, a fractured pelvis, and a traumatic brain injury.
These patients are at increased risk of internal bleeding, shock, and other life-threatening complications.
EMTs should recognize serious injuries, treat immediate life threats, request additional resources when needed, and arrange prompt transport to an appropriate trauma center.
Key Tip
Serious trauma may be present even when external injuries appear minor. Consider the mechanism of injury, assess for hidden bleeding and organ damage, and prioritize immediate life threats. Patients with significant head, chest, abdominal, or multisystem injuries often require rapid transport to a trauma center.