Before I embark on the next article in the Trauma Care series, I thought I would define what ‘multisystem trauma‘ is, and why it is so important to recognise and understand the treatment protocols.
It is key to understand the difference between ‘multiple trauma’ and ‘multisystem trauma’.
A trauma in which the patient has more than one serious injury
Multiple injuries that affect more than one body system
Trauma is the leading cause of death in the UK and in Thailand, is the second leading cause of death.
Since 1990, trauma has become the second leading cause of death (heart disease is first) in Thailand, and road traffic crashes have resulted in the most frequent injuries. Approximately 66,300 people died in road traffic crashes from 2002 to 2006, an average of 13,260 deaths per year (equivalent to 24/100,000 population). Some 5 million people were injured, and several hundreds of thousands of those injured have become permanently disabled. The economic loss resulting from traffic accidents was estimated at 200,000 million Bahts (approximately US$ 5 billion), roughly 3.1% of the country’s gross national product.
(refer to source article)
Trauma management by EMS crews is essential, and needs planning and preparation. Failure to plan is planning to fail.
It is essential that there is a rapid differentiation between patients with multisystem trauma and those with what could be called ‘simple trauma‘. The needs of each of these categories of patients is very different. A patient with multisystem trauma should be always considered as ‘unstable’, it will be the role of the trauma unit at the hospital to make a differential diagnosis and provide appropriate treatment and interventions.
It is key that there is NO DELAY in transport to hospital. The golden hour comes into effect.
What is the golden hour?
A variety of independent studies published in the past few years have shown that the initiation of transport to a proper facility without delay is one of the key EMT treatments affecting survival in patients with multisystem trauma. The concepts of the golden hour from injury to management and the golden 10 minutes in the field, along with increasing potential for permanent injury and mortality that results from each delay in definitive care, are usually accepted axioms of current trauma care (4th ed PHTLS, p304, MOSBY)
While treatment protocols will vary marginally country to country, there is one thing that we need to remember:
Do we ‘stay and play’ OR ‘load and go’?
LOAD AND GO
This is not the time for in depth getting to know your patient, this is the time to manage the injuries, revert back to basics, stop catastrophic bleeding, airway management, cspine immobilisation if appropriate, manage severe injuries where appropriate, package your patient and GO! And yes, you can do this in 10 minutes or less (exceptions to this would be where your patient is trapped in a car accident or industrial incident etc – then you will need to revise and plan!)