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Home > List Archives

Pre-hospital Primary Survey

MARK FORREST trauma-list@trauma.org
Sun, 13 Apr 2003 22:51:05 +0100


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Dear Paul,=20
Interesting question! We can all quote the textbook answers, but what =
about real world......3am, pouring rain, car on roof, cutting gear =
running!

On arrival on scene our team follow two basic courses.
If there is obvious massive external bleeding we apply 'MARCH'

M- massive haemorrhage control eg direct pressure, arterial pressure =
(?tourniquet - discuss!). This is all about preservation of circulatory =
volume...his own blood volume!
This should not take more than a few seconds and should not delay =
movement onto airway. Even ATLS recommends immediate pressure dressings =
to obvious bleeding wounds.
The rest is basically A,B.C
A - airway
R -respiration
C- circulation
H - head injury

MARCH - focuses the medics onto the primary problem, but does not =
distract them from other essential issues.

If there is no obvious massive bleeding, then we follow a standard =
A,B,C.... approach.
On approach attempting verbal contact - indicates conscious level and =
airway quality (if talking and orientated, no immediate head problem, =
not seriously shocked, not hypoxic/hypercarbic).
Pulse oximeter immediately applied - indicates oxygen saturation, =
peripheral perfusion/degree of 'shut-down' or hypothermia and heart =
rate.
If sats Ok - move onto 'C'=20
If sats are poor, then fully assess chest from trachea down (largely =
looking and feeling, percussion usually possible, auscultation rarely =
possible without stopping the extrication and if it is not barn-door =
then it can probably wait until extrication complete!)=20
C  - conscious level continually assessed
    - radial pulse, if palpable give no fluid
    - no radial then feel for central pulse - no central pulse consider =
other signs (blunt trauma with no output - are they dead already?)
    - capillary refill, forehead or finger
    - no radial pulse and prolonged cap refill then give fluid bolus of =
100-250 ml (usually hypertonic saline with starch or dextran)
    - continually re-assess response whilst extrication continues
D - AVPU, until extricated then GCS
    - pupils
    - quick check of limbs for signs of serious injury

Aim to rapidly assess and to primarily detect seriously life-threatening =
injuries whilst not delaying continuos extrication process. This process =
is better facilitated as our team train docs, techs, fire-fighters and =
paramedics together, with lots of skill overlap.

Hope that this helps Paul


Regards
Mark F
ATACC Medical Rescue Team, UK

  ----- Original Message -----=20
  From: delta care uk=20
  To: trauma-list@trauma.org=20
  Cc: NAEMT-L@naemt.org ; NAEMT-L@naemt.org EMED-L List ; NAEMT-R ; =
EMS-L List Server ; Critical Care Medicine List=20
  Sent: Sunday, April 13, 2003 7:18 PM
  Subject: Pre-hospital Primary Survey


  Could list members help off list if need be.=20
  I am looking for the various sequences and methods of pre- hospital =
primary survey.=20
   =20
  I am interested in everybody's viewpoint especially from those =
involved in MVA/RTA incidents. I am consolidating information in what =
pre hospital providers have found to be useless or what people have =
found to be priceless when involved in entrapments, where access to the =
casualty may be limited etc.=20

  All information will be relevant.=20

  Thanks in advance,=20

  Paul Cooper=20
  Fire fighter UK=20

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<HTML><HEAD>
<META http-equiv=3DContent-Type content=3D"text/html; =
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<BODY bgColor=3D#ffffff>
<DIV><FONT face=3DArial size=3D2>Dear Paul, </FONT></DIV>
<DIV><FONT face=3DArial size=3D2>Interesting question! We can all quote =
the textbook=20
answers, but what about real world......3am, pouring rain, car on roof, =
cutting=20
gear running!</FONT></DIV>
<DIV><FONT face=3DArial size=3D2></FONT>&nbsp;</DIV>
<DIV><FONT face=3DArial size=3D2>On arrival on scene our team follow two =
basic=20
courses.</FONT></DIV>
<DIV><FONT face=3DArial size=3D2>If there is obvious massive =
external&nbsp;bleeding=20
we apply <STRONG>'MARCH'</STRONG></FONT></DIV>
<DIV><FONT face=3DArial size=3D2></FONT>&nbsp;</DIV>
<DIV><FONT face=3DArial size=3D2><STRONG>M- massive haemorrhage =
control</STRONG> eg=20
direct pressure, arterial pressure (?tourniquet - discuss!). This is all =
about=20
preservation of circulatory volume...his own blood volume!</FONT></DIV>
<DIV><FONT face=3DArial size=3D2>This should not take more than a few =
seconds and=20
should not delay movement onto airway. Even ATLS recommends immediate =
pressure=20
dressings to obvious bleeding wounds.</FONT></DIV>
<DIV><FONT face=3DArial size=3D2>The rest is basically =
A,B.C</FONT></DIV>
<DIV><FONT face=3DArial size=3D2><STRONG>A - =
airway</STRONG></FONT></DIV>
<DIV><FONT face=3DArial size=3D2><STRONG>R =
-respiration</STRONG></FONT></DIV>
<DIV><FONT face=3DArial size=3D2><STRONG>C- =
circulation</STRONG></FONT></DIV>
<DIV><FONT face=3DArial size=3D2><STRONG>H - head =
injury</STRONG></FONT></DIV>
<DIV><FONT face=3DArial size=3D2></FONT>&nbsp;</DIV>
<DIV><FONT face=3DArial size=3D2>MARCH - focuses the medics onto the =
primary=20
problem, but does not distract them from other essential =
issues.</FONT></DIV>
<DIV><FONT face=3DArial size=3D2></FONT>&nbsp;</DIV>
<DIV><FONT face=3DArial size=3D2>If there is no obvious massive =
bleeding, then we=20
follow a standard A,B,C.... approach.</FONT></DIV>
<DIV><FONT face=3DArial size=3D2><STRONG>On approach attempting verbal=20
contact</STRONG> - indicates conscious level and airway quality&nbsp;(if =
talking=20
and orientated, no immediate head problem, not seriously shocked, not=20
hypoxic/hypercarbic).</FONT></DIV>
<DIV><FONT face=3DArial size=3D2><STRONG>Pulse oximeter immediately =
applied</STRONG>=20
- indicates oxygen saturation, peripheral perfusion/degree of =
'shut-down' or=20
hypothermia and&nbsp;heart rate.</FONT></DIV>
<DIV><FONT face=3DArial size=3D2><STRONG>If sats Ok - move onto =
'C'</STRONG>=20
</FONT></DIV>
<DIV><FONT face=3DArial size=3D2><STRONG>If sats are poor, then fully =
assess chest=20
from trachea down</STRONG> (largely looking and feeling, percussion =
usually=20
possible, auscultation rarely possible without stopping the extrication =
and if=20
it is not barn-door then it can probably wait until extrication=20
complete!)&nbsp;</FONT></DIV>
<DIV><FONT face=3DArial size=3D2><STRONG>C&nbsp;&nbsp;- conscious level =
continually=20
assessed</STRONG></FONT></DIV>
<DIV><FONT face=3DArial size=3D2>&nbsp;&nbsp;&nbsp; - <STRONG>radial =
pulse</STRONG>,=20
if palpable give no fluid</FONT></DIV>
<DIV><FONT face=3DArial size=3D2>&nbsp;&nbsp;&nbsp; - no radial then =
feel for=20
central pulse - no central pulse consider other signs (blunt trauma with =
no=20
output - are they dead already?)</FONT></DIV>
<DIV><FONT face=3DArial size=3D2>&nbsp;&nbsp;&nbsp; - <STRONG>capillary=20
refill</STRONG>, forehead or finger</FONT></DIV>
<DIV><FONT face=3DArial size=3D2>&nbsp;&nbsp;&nbsp; - no radial pulse =
and prolonged=20
cap refill then give fluid bolus of 100-250 ml (usually hypertonic =
saline with=20
starch or dextran)</FONT></DIV>
<DIV><FONT face=3DArial size=3D2>&nbsp;&nbsp;&nbsp; - =
<STRONG>continually=20
re-assess</STRONG> response whilst extrication continues</FONT></DIV>
<DIV><FONT face=3DArial size=3D2><STRONG>D - AVPU, until extricated then =

GCS</STRONG></FONT></DIV>
<DIV><FONT face=3DArial size=3D2>&nbsp;&nbsp;&nbsp; -<STRONG>=20
pupils</STRONG></FONT></DIV>
<DIV><FONT face=3DArial size=3D2>&nbsp;&nbsp;&nbsp; <STRONG>- quick =
check of limbs=20
for signs of serious injury</STRONG></FONT></DIV>
<DIV><STRONG><FONT face=3DArial size=3D2></FONT></STRONG>&nbsp;</DIV>
<DIV><FONT face=3DArial size=3D2>Aim to rapidly assess and=20
to&nbsp;primarily</FONT><FONT face=3DArial size=3D2>&nbsp;detect =
seriously=20
life-threatening injuries whilst not delaying continuos extrication =
process.=20
This process is better facilitated as our team train docs, techs, =
fire-fighters=20
and paramedics together, with lots of skill overlap.</FONT></DIV>
<DIV><FONT face=3DArial size=3D2></FONT>&nbsp;</DIV>
<DIV><FONT face=3DArial size=3D2>Hope that this helps Paul</FONT></DIV>
<DIV><FONT face=3DArial size=3D2></FONT>&nbsp;</DIV>
<DIV><FONT face=3DArial size=3D2></FONT>&nbsp;</DIV>
<DIV><FONT face=3DArial size=3D2>Regards</FONT></DIV>
<DIV><FONT face=3DArial size=3D2>Mark F</FONT></DIV>
<DIV><FONT face=3DArial size=3D2>ATACC Medical Rescue Team, =
UK</FONT></DIV>
<DIV><FONT face=3DArial size=3D2></FONT>&nbsp;</DIV>
<BLOCKQUOTE dir=3Dltr=20
style=3D"PADDING-RIGHT: 0px; PADDING-LEFT: 5px; MARGIN-LEFT: 5px; =
BORDER-LEFT: #000000 2px solid; MARGIN-RIGHT: 0px">
  <DIV style=3D"FONT: 10pt arial">----- Original Message ----- </DIV>
  <DIV=20
  style=3D"BACKGROUND: #e4e4e4; FONT: 10pt arial; font-color: =
black"><B>From:</B>=20
  <A title=3Ddelta.uk@ntlworld.com =
href=3D"mailto:delta.uk@ntlworld.com">delta care=20
  uk</A> </DIV>
  <DIV style=3D"FONT: 10pt arial"><B>To:</B> <A =
title=3Dtrauma-list@trauma.org=20
  href=3D"mailto:trauma-list@trauma.org">trauma-list@trauma.org</A> =
</DIV>
  <DIV style=3D"FONT: 10pt arial"><B>Cc:</B> <A =
title=3DNAEMT-L@naemt.org=20
  href=3D"mailto:NAEMT-L@naemt.org">NAEMT-L@naemt.org</A> ; <A=20
  title=3DEMED-L@ITSSRV1.UCSF.EDU=20
  href=3D"mailto:NAEMT-L@naemt.org EMED-L List">NAEMT-L@naemt.org EMED-L =
List</A>=20
  ; <A title=3DNAEMT-R@naemt.org =
href=3D"mailto:NAEMT-R@naemt.org">NAEMT-R</A> ; <A=20
  title=3Dems-l@listserv.unc.edu =
href=3D"mailto:ems-l@listserv.unc.edu">EMS-L List=20
  Server</A> ; <A title=3Dccm-l@list.pitt.edu=20
  href=3D"mailto:ccm-l@list.pitt.edu">Critical Care Medicine List</A> =
</DIV>
  <DIV style=3D"FONT: 10pt arial"><B>Sent:</B> Sunday, April 13, 2003 =
7:18=20
PM</DIV>
  <DIV style=3D"FONT: 10pt arial"><B>Subject:</B> Pre-hospital Primary=20
Survey</DIV>
  <DIV><BR></DIV>Could list members help off list if need be.=20
  <P>I am looking for the various sequences and methods of <B>pre- =
hospital</B>=20
  primary survey. <BR>&nbsp; <BR>I am interested in everybody's =
viewpoint=20
  especially from those involved in MVA/RTA incidents. I am =
consolidating=20
  information in what pre hospital providers have found to be useless or =
what=20
  people have found to be priceless when involved in entrapments, where =
access=20
  to the casualty may be limited etc.=20
  <P>All information will be relevant.=20
  <P>Thanks in advance,=20
  <P>Paul Cooper <BR>Fire fighter UK </P></BLOCKQUOTE></BODY></HTML>

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