First Responder EMS Curriculum for Training Centers in Eurasia

soft tissue injuries. Remember, the top priorities are maintenance of the airway,breathing, circulation, and full spine immobilization.Assessment should include obtaining a history of the traumatic event, includingcircumstance, mechanism of injury, and extent of damage at the scene. Try to obtain thepatient’s initial mental status at the scene, and monitor the patient for mental statusdeterioration frequently. Other important information would include the time of theinjury, vehicular damage, use of seatbelts, extrication time, and the presence or absenceof a loss of consciousness.ManagementComplete a scene assessment. Maintain body substance isolation. Perform the PrimarySurvey (“ABCD”). Assess the patient’s airway, and maintain and support breathing asnecessary with cervical-spine immobilization. Assess the patient’s circulation, andprovide hemorrhage/bleeding control. Assess the patient’s initial disability, neurologicstatus, and perform frequent, ongoing assessments. Comfort, calm, and reassure thepatient until additional EMS personnel arrive to help.b. Abdominal/Genitourinary TraumaInjury to the abdominal and genitourinary organs may be difficult to assess at the scenebecause of the presence of other injuries, or the presence of an altered mental status,which makes the abdominal exam unreliable. It is not important for the First Responderto isolate and identify the specific abdominal injury. It is, however, important to beaware of the possibility of internal injury to abdominal organs, which can lead tosignificant blood loss.There are two primary mechanisms of injury. Blunt trauma may result from a motorvehicle accident, contact sports, or a violent altercation. The liver and spleen are mostcommonly injured from blunt trauma. Penetrating trauma occurs most frequently withgunshot wounds or stab wounds. Assessment of the patient’s abdomen includesvisualization for bruises on the abdomen, pelvis, or back, as well as abdominaldistension. It also includes palpation of the abdomen and pelvis to assess for pain.ManagementComplete a scene assessment. Maintain body substance isolation. Control the patient’sairway and breathing. Maintain cervical-spine immobilization. Assess the circulationand provide bleeding control. Assess the patient for abdominal and pelvic injury.Comfort, calm, and reassure the patient until additional EMS personnel arrive to help.8. Application of Content Materiala. Procedural (How)1. Show diagrams of the muscular and skeletal systems.2. Show the visual signs of open and closed bone and joint injuries.3. Demonstrate the assessment of an injured extremity.4. Demonstrate manual stabilization techniques using the general rules of splinting.b. Contextual (When, Where, Why)1. Injuries to bones and joints require immediate stabilization unless life-threateninginjuries are present. If life-threatening injuries are present, ignore extremity injuriesuntil the immediate problem is addressed.178 First Responder EMS Curriculum/AIHA, July 2002