First Responder EMS Curriculum for Training Centers in Eurasia

observers at the scene. Try to determine the mechanism of injury and the patient’smental status.c. ManagementComplete a scene assessment. Maintain body substance isolation. Establish andmaintain manual stabilization of the head and neck. Manual stabilization should onlystop after additional EMS personnel have appropriately positioned the patient on abackboard with the head stabilized. After manual stabilization, perform an initialassessment. Control the patient’s airway without moving the patient’s head, using thejaw-thrust maneuver, if necessary. Whenever possible, artificial ventilation should beperformed without moving the patient’s head. Once you have assessed and maintainedthe patient’s airway and breathing, assess the patient’s pulse (circulation) and motor andsensory function in all extremities (disability).6. Injuries to the Brain and SkullInjuries to the head may result in injuries to the scalp, skull, or underlying brain. Headinjuries are classified as either open or closed. Open injuries require penetration of thescalp and present with bleeding. Closed injuries of the head have no penetration of thescalp. These injuries may appear deceptively minor, despite significant underlying braininjury. Patients with closed head injury may present with swelling of the scalp ordepression of skull bones.Scalp injuries are rarely life threatening, but may result in large amounts of blood lossbecause of the significant numbers of blood vessels in the scalp. Treatment of these injuriesstarts with direct pressure to control bleeding.Injuries to the brain may result in bleeding or swelling of brain tissue within the skull.Because the bony skull does not expand, this results in increased pressure on the brain,which, in turn, can lead to confusion, unconsciousness, as well as respiratory and cardiacarrest.a. ManagementComplete a scene assessment. Observe body substance isolation guidelines. Maintainthe patient’s airway/artificial ventilation/oxygenation. The initial patient assessmentwith manual spinal stabilization should be done on scene where the patient was injured(unless the scene is not safe for you or the patient). During ongoing assessments of thepatient’s airway, breathing, and circulation, also frequently monitor the patient’s mentalstatus for deterioration. If there is any bleeding from the scalp, apply enough directpressure to control the bleeding, without disturbing the underlying tissue. Finally, dressand bandage any open wound as indicated in the emergency medical care of soft tissueinjuries.7. Special Considerationsa. Multiple TraumaPatients sustaining traumatic injury may suffer from an isolated injury or multipleinjuries. There are three basic mechanisms of injury: blunt trauma, penetrating trauma,and trauma from blasts or explosions. When a patient has multiple injuries, the FirstResponder must prioritize evaluation and management of the patient’s injuries. First,address life-threatening injuries such as respiratory or cardiac failure. Second, once youhave managed life-threatening injuries, assess and treat other injuries, such as bone andFirst Responder EMS Curriculum/AIHA, July 2002 177