Trauma Systematic Patient Assessment in the Austere Environment

Systematic patient assessment skills that save time and allows the first responder to perform life-saving interventions.  Applying your system, knowing your skills, and knowing your equipment and recourse all for better patient outcomes.

As public safety and first responder education company, Systematic Patient Assessment (PSA) skills and critical thinking is where we focus a lot of training time with our students.  Whether you are in the backcountry or working an active shooting situation, the primary trauma assessment is the same.  Sure some of our equipment and tools may vary, but the system we educate and train our students to utilize are the same.  This is the key to success when managing your patient and their treatment.  By having a systematic assessment procedure allows you to manage your scene, identify life threats, treat and manage your patient.  Typical in all austere environments that we operate in, critically thinking through the extrication of your patient is the crux of patient management and good outcomes. Utilizing algorithms like MARCHE, or SALT to manage your patient is a great way to get a system down.  Understanding the THREATS that can impact you and your team's safety is key to survival for all.  Here at VAMS we utilize the MARCHE algorithm to all trauma. 

Massive Bleeding Control (Tourniquets, Wound Packing, Pressure Bandages) 
Airway management (Naso Pharnigyl, Supra glottic, Surgical cric, tracheal intubation  
Respiratory Management (positioning, occlusive dressings, needle decompression)
Circulation / Shock management (fluids, volume expanders, blood products, warming)
Head injuries (Traumatic brain injury management, eye injury management)
Everything else (secondary exam, reassess, management of other injuries)

Massive hemorrhage control is still the leading preventable cause of death in this country. Aggressively managing your patient is imperative, knowing which tools to apply and when must be rehearsed and practiced in all conditions and situations.  Airway management must be addressed and is the leading cause of death in traumatic events.  Breathing management is another preventable cause of death and if not recognized quickly will lead to your patient's demise.  Managing your patient traumatic injuries including the mechanism of injury MOI in an aggressive and systemic way allows for best patient outcomes.  Managing your patient's extrication is also, imperative to patient survivability because definitive care is not in the field but typically in the operating room under surgeon's care. Managing your scene can be an obstacle in the austere environment. Safety for first responders and the patient is so important.  It is our responsibility to manage our scene and is stressed at every level of pre-hospital medical training.

A good tool we utilize is SALT.  It helps with a systematic approach to managing your patient's scene, treatment, and extrication.

Scene (safe, managing hazards of the scene, additional resources to manage a scene
Assessment (assessment of number of patients, what is the MOI, priority or types of multiple patients
Life-Saving Interventions (hemorrhage control, airway management, breathing management)
Treatment and transport (extended medical treatment plans, types of extrication tools and resources)

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