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Pre-hospital Primary Survey

Jeff Brosius trauma-list@trauma.org
Mon, 14 Apr 2003 09:01:03 -0400

For whatever it may be worth, here's how I approach a trauma victim, 
step-by-step.  Understand that this will probably grate every last nerve of 
some of our list members (Drs. McSwain, Salomone, etc.)

1) Any danger to me, my partner, or anyone else?
2) Look for the overall mechanism.  Keep this in the back of my mind, but 
do NOT let it be the overriding factor in the equation.)
3)  Walk in, slowly.  Any danger to me or crew?  If not, then look at the 
4) Any blood on the ground?  If lots, then time to go to the ER.  Fix what 
I can enroute.
5) Can he/she talk? If not, time to go to the ER.  Fix what I can enroute.
6) If not talking, look at airway.  If talking, can he/she breathe?
7) If breathing, rate/rhythm/quality?  Any of these abnormal, then it's 
time to go to the ER.  I'll fix any problems enroute.
8) If breathing normal, check the skin and radial pulse.  If either is 
abnormal, time to go, and fix enroute.
9) If talking, breathing, pulsing, and not bleeding, then move on.... 
thorough exam, provide treatment when appropriate, and transport.

To the prehospital provider, useless informations includes the 
following:  Blood Pressure, past medical history, medication allergies, 
social history (to include EtOH/Substance/etc.,) and ECG monitoring.

As a general rule, a decent medic should have a fairly good overview of the 
patient condition within 60 seconds of entering the doorway (i.e. "Damn," 
or "Crap.")


Jeff Brosius
Paramedic, etc.
Atlanta, GA
"...deliver them that are drawn unto death."
Proverbs 24:11 (NIV)

At 07:18 PM 4/13/2003 +0100, you wrote:
>Could list members help off list if need be.
>I am looking for the various sequences and methods of pre- hospital 
>primary survey.
>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.
>All information will be relevant.
>Thanks in advance,
>Paul Cooper
>Fire fighter UK