⚠️ Trauma — Load and Go if time-critical — NWAS MTC pre-alert required
Mechanism of Injury MOI
RTC occupant
RTC motorcyclist
Pedestrian struck
Cyclist struck
Fall from height
Fall same level
Assault blunt
Stab wound
GSW
Blast
Burns
Industrial
Sport
Near-drowning
Hanging
⚡ High-energy mechanisms mandate MTC consideration: Speed >30mph, pedestrian/cyclist thrown, death of co-occupant, fall >6m, intrusion >30cm, rollover, ejection from vehicle
RTC — Scene Details
Speed of impact (estimated) — documented
Seatbelt worn — lap / three-point / none
Airbags deployed — frontal / side / curtain
Ejection from vehicle — full / partial
Rollover — number of rolls
Intrusion into occupant space — side / frontal / roof
Patient position in vehicle (driver / passenger / rear)
Helmet worn (motorcycle/cyclist) — intact / damaged
Fall Details
Height of fall — document in metres
Surface landed on — concrete / grass / water / other
Landing position — feet / seated / back / head first
Intentional fall — consider safeguarding / MH
Medical cause of fall — syncope, seizure, ACS, arrhythmia
How long on floor before found — lying time
Intoxication or substance use at time of fall
Penetrating / Stabbing / GSW
Weapon type / estimated size (knife length etc.)
Number of wounds — anterior / posterior / lateral
Entry and exit wounds documented separately
Direction of force / trajectory (if estimable)
Body cavities at risk — chest / abdomen / neck / groin
Volume of blood at scene — estimated
Weapon recovered / scene made safe (Police aware)
Burns
Airway involvement — singed nasal hair, hoarseness, soot in airway, stridor
Circumferential burns — limb / chest (escharotomy risk)
Burns to face / hands / genitalia — specialist centre
Inhalation injury suspected — CO poisoning
Duration of exposure documented
Irrigated / decontaminated on scene (chemical)
None
Alcohol
Drugs
Primary Survey cABCDE
Treat threats to life as identified — do not proceed until each step is managed
c — Catastrophic Haemorrhage
Catastrophic external bleeding identified and controlled
Tourniquet applied — limb, time of application
Wound packing — haemostatic gauze / standard
Direct pressure maintained — time pressure started
Haemorrhage control confirmed — no further exsanguinating blood loss
A — Airway (with C-spine)
Airway patent — self-maintaining
Airway compromised — obstruction identified
C-spine immobilisation considered (MOI / neurology)
Manual in-line stabilisation (MILS) applied
Jaw thrust / chin lift used
Suction performed — blood / secretions
OPA / NPA inserted — size
SGA (iGel/LMA) inserted — size
Intubation performed — ETT size, depth, confirmed
Surgical airway (cric) — CICO
B — Breathing
Chest rise — bilateral / asymmetrical
Air entry — bilateral / reduced / absent (side)
Respiratory rate — normal / tachypnoeic / bradypnoeic / apnoeic
O₂ applied — device, flow rate, target SpO₂
Open chest wound (sucking wound) — sealed with 3-sided dressing
Tension pneumothorax suspected — decompressed (site, gauge)
Massive haemothorax suspected — drain at ED
Flail segment — paradoxical chest movement (ribs involved)
Trachea deviation — toward / away from injury
Surgical emphysema — crepitus on palpation
Rib tenderness / crepitus — ribs involved (number)
Assisted ventilation — BVM, rate, tidal volume
C — Circulation
HR — rate, rhythm, quality
BP — document, interpret in context of injury
Skin — colour (pallor / mottling), temperature (cool / cold)
Haemorrhagic shock suspected — assess class (I–IV)
IV access — site, gauge, number of attempts
IO access — site, device (EZ-IO), flush confirmed
IV fluid — type, volume, rate (permissive hypotension considered)
TXA administered — dose, time, route
Pelvic binder applied — TPOD / SAM Pelvic Sling
Long bone splintage — traction (femur) / Kendrick / box splint
Pericardial tamponade suspected (Beck's triad)
12-lead ECG — rhythm, injury pattern
D — Disability (Neurological)
GCS — E/V/M — total score
AVPU — Alert / Voice / Pain / Unresponsive
Pupils — equal / unequal, reactive / fixed, size (mm)
Unequal or dilated pupils — herniation / direct eye trauma
Focal limb weakness — distribution (UMN / spinal cord pattern)
Priapism — consider spinal cord injury
LOC — duration, witnessed, post-ictal features
Lucid interval followed by deterioration — extradural haematoma
C-spine assessment — sensory / motor deficit at level
E — Exposure
Full exposure performed — all surfaces examined
Temperature — hypothermia risk assessed, warming measures applied
Log roll performed — posterior surface assessed
Injuries found on posterior surface — documented
Perineal / genitalia injuries documented
All wounds covered / dressed
Patient rewarmed / insulated — hypothermia prevention
Injury Catalogue
Document every injury — location, type, size, depth, neurovascular status distal
Distal pulses present in injured limbs — documented
Absent pulse distal to injury — vascular injury suspected
Sensation intact distal to injury
Sensory deficit distal to injury — nerve injury suspected
Motor function intact distal to injury
Secondary Survey Head-to-Toe
Complete only if time/scene allows — do not delay transport for critical patients
Head and Face
Scalp laceration — location, depth, length, active bleeding
Skull deformity / depression — location
Battle's sign (mastoid bruising) — delayed sign of basal skull #
Raccoon eyes (periorbital) — delayed sign of basal skull #
CSF from nose or ears (halo test)
Facial bones — midface stability (Le Fort), zygomatic
Mandible / jaw fracture — dental occlusion abnormal
Eye injury — hyphema, lid laceration, visual acuity change
Ear — haemotympanum, laceration
Neck and C-spine
Midline c-spine tenderness — level
Neck vein distension (JVD) — bilateral / unilateral
Tracheal deviation — deviated side
Carotid bruit / pulsatile haematoma — vascular injury
Surgical emphysema — palpable crepitus
Penetrating neck wound — zone (I/II/III)
C-spine protection maintained throughout
Chest
Rib palpation — tender ribs, crepitus (number, location)
Sternum tender — sternal fracture
Flail segment — paradoxical movement confirmed
Wound — open chest wound (site, size)
Haemorrhage from chest wound — volume
Cardiac monitoring findings — arrhythmia, contusion pattern
Abdomen
Seat belt sign / bruising — distribution across abdomen
Distension — degree, tenderness
Guarding / rigidity / involuntary guarding
Evisceration — bowel/omentum visible
Penetrating abdominal wound — number, location
Impaled object — do NOT remove, stabilise in situ
Pelvis
Pelvic springing — instability (do once only)
Unstable pelvis — pelvic binder applied, do not spring again
Scrotal / labial haematoma — consider pelvic # / urethral injury
Perineal lacerations — open pelvic fracture pattern
Urethral blood — do not catheterise, flag to ED
Extremities
All four limbs examined — bony tenderness, deformity
Fracture splinted — method, distal NVS pre/post
Femur fracture — traction splint (Kendrick/Thomas) applied
Open fracture — dressed, antibiotics (co-amoxiclav / flucloxacillin)
Traumatic amputation — tourniquet, stump dressing, preserve part
Dislocations — document pre-reduction NVS
Compartment syndrome risk — pain on passive stretch, tense compartment
Posterior Surface (Log Roll)
Log roll performed — number of personnel
Posterior thoracic tenderness / step deformity
Lumbar tenderness — level
Posterior wounds / lacerations documented
Perineal inspection — wounds, PR blood
Vital Signs / Obs
Serial observations — re-assess after every intervention. Document trend not just single values.
Lethal triad: Hypothermia + Acidosis + Coagulopathy — prevent aggressively, warm all fluids, minimise heat loss
Trauma-Relevant Medical History AMPLE
AMPLE — Allergies, Medications, Past history, Last meal, Events
NKDA
Penicillin
NSAIDs
Opioids
TXA
⚠️ Anticoagulants (warfarin/DOACs) — increases haemorrhage risk. Beta-blockers — masks tachycardia in shock. Steroids — immunosuppression, adrenal insufficiency.
Cardiac
Respiratory
Diabetes
Coagulopathy
Splenectomy
Anticoagulated
Prev surgery
Social History — Trauma Context
Injury pattern inconsistent with stated mechanism
Signs of domestic violence / intimate partner violence
Injuries at different stages of healing — non-accidental injury
Delay in calling for help — inconsistent with severity
Child present — welfare referral required
Intentional self-harm / attempted suicide
Third party involvement — police involvement
Clinical Impression & Trauma Criteria
If any MTC criteria met — pre-alert MTC and convey direct
Penetrating injury to head, neck, torso or proximal limb
Two or more proximal long bone fractures
Crushed / degloved / mangled extremity
Amputation proximal to wrist or ankle
Paralysis / suspected spinal cord injury
Open or depressed skull fracture
Pelvic fracture (unstable)
High energy mechanism — speed >60mph, fall >6m
No pre-alert
MTC pre-alert
Local ED
ATMIST
Management / Treatment
Trauma philosophy: Control haemorrhage → airway → breathing → circulation → rapid transport. Minimise on-scene time.
Haemorrhage control — tourniquet / packing / direct pressure (time)
O₂ therapy — device, flow rate
Needle decompression — site, gauge (with time)
Chest seal applied — brand, 3-sided or vented
IV access — site(s), gauge(s)
IO access — site, device, confirmed
IV fluid — type, volume, rate (permissive hypotension target)
TXA administered — 1g IV (within 3 hours)
Analgesia — drug, dose, route, time
Pelvic binder — applied, not compressed
Traction splint (femur fracture)
C-spine immobilisation — collar size / standing takedown / supine packaging
Spinal packaging — long board / scoop / vacuum mattress
Wound dressing / bandaging — type applied
Warming — hypothermia prevention (foil blanket, heated vehicle)
Patient packaged and ready for transport
Conscious patient — consent for treatment and transport obtained
Unconscious / incapacitated — MCA best interests decision, documented
DNACPR sighted and decision made regarding resuscitation
TCA (traumatic cardiac arrest) — JRCALC criteria applied
Gaps & Additional Considerations
Exact mechanism unknown — unconscious/confused patient
Time of injury not established
Medication history unavailable
No witness account available
Posterior surface not fully assessed — packaged in collar/scoop
Hidden injuries possible — multi-compartment bleeding
Suspected occult haemorrhage — abdomen / pelvis / thorax
C-spine not cleared — maintain immobilisation
Tourniquet on — time noted, requires conversion
TXA given — second dose may be required
Safeguarding — refer to hospital team
Police involvement — crime scene, forensic evidence preserved
Hypothermia — rewarming required
Anticoagulation — reversal may be required
Tetanus immunisation required
PRF Text Output