First Responder EMS Curriculum for Training Centers in Eurasia

Sharp, pointed objects cause penetration injuries, or puncture wounds. These injuriesmay deceptively conceal internal bleeding of structures beneath the skin. Extent ofinjury depends on the object causing the wound, the velocity of the object, and theunderlying structures damaged by the penetrating object. Puncture wounds may have anexit wound as well as an entrance wound. Examples of such penetrating injuries includegunshot and stab wounds.b. Role of the First ResponderComplete the First Responder assessment. Complete a scene size-up before initiatingemergency medical care. Complete an initial assessment on all patients. Complete aphysical exam as needed. Complete ongoing assessments. Comfort, calm, and reassurethe patient while waiting for additional EMS personnel.c. ManagementIt is necessary to maintain body substance isolation whenever managing any soft tissueinjury. Gloves and eye protection are crucial for preventing transmission of disease.Wearing a gown is also highly recommended, if available. Washing hands to preventdisease transmission cannot be overstated. Remember that body substance isolationguidelines are for your protection, as well as for the patient.The first step in managing soft tissue injuries is to maintain a proper airway and assist inventilation, as necessary. Remember the ABCs. Once you have evaluated andmaintained the airway, breathing, and circulation, management of open soft tissueinjuries includes:1. Exposing the wound.2. Controlling the bleeding and preventing further blood loss.3. Preventing further contamination of the wound by covering with sterile dressings, ifavailable, or cloth towels/blankets, etc.4. Applying sterile dressing to the wound and bandaging securely in place.5. Special Considerationsa. Chest InjuriesChest injuries can involve chest wall injuries as well as internal injuries to the lungs andheart. When open wounds are present in the chest, place an occlusive dressing over thewound and seal on three sides. This technique allows air to escape the chest cavityduring exhalation while preventing air from entering the chest cavity with inhalation.This method will help prevent the creation of a tension pneumothorax (lung collapse,which causes increased pressure within the chest cavity, resulting in a potentially fatalreduction in heart function and cardiac arrest). If no spinal injury is suspected, thepatient should be placed in a position of comfort.b. Impaled ObjectsImpaled objects also require special consideration. To manage these injuries, the FirstResponder must never remove the impaled object from the injured patient, unless it isthrough the cheek or in a position that interferes with airway management or chestcompressions. It is important to secure the object in place to prevent further injury.Expose the wounded area, control the bleeding, and cover the area with a bulky dressingto help stabilize the impaled object.160 First Responder EMS Curriculum/AIHA, July 2002