BASIC LIFE SUPPORT

PRE-HOSPITAL Trauma Protocol:

Head/Neck/Spine Injuries

TREATMENT PROTOCOLS
ASSESMENT
1. DO NOT HYPEREXTEND NECK.
2. Perform Rapid Trauma Assessment. Be sure to note
mechanism of injury.
3. Assume cervical spine injury to be present in all trauma patients.
4. Perform neurological exam assessing level of consciousness.
A - Patient is alert
V - Patient responds to voice stimuli
P - Patient responds to painful stimuli
U - Patient is unresponsive
See Glasgow coma scale.
See Trauma score.
5. Obtain history (i.e., helmet or seat belt use) and level of consciousness since injury.
6. Note cerebrospinal fluid from ears, nose, mouth.
7. Check for associated injuries.
TREATMENT

1. Secure airway per spine injury protocol.

2. Administer 100% oxygen via non-rebreather mask. If ventilation assistance is
needed, bagvalve- mask with reservoir (100% O2) at 24 times per minute.
(Remember to have suction immediately available).
3. Realign neck to a neutral, in-line position unless resistance is met.
4. MANUALLY stabilize head, neck and spine until secured on appropriate device.
DO NOT APPLY TRACTION.
5. Continuously monitor and record all observations.
6. If shock is present, see Trauma Protocol Shock
 BASIC LIFE SUPPORT
PRE-HOSPITAL Trauma Protocol:
Children

TREATMENT PROTOCOLS
ASSESSMENT
1. Perform Rapid Trauma Assessment for adults. (See Trauma Protocol #2, page 4.)
2. Be aware of anatomical and developmental differences in children.
Head: Head injuries cause over half of pediatric trauma deaths and 75% of all
pediatric trauma involves head injury. The head is largerin proportion to the rest of
the body and children are more likely to have cerebral swelling than adults.
Chest: The chest wall is more elastic; therefore, a child can have significant internal
injury with no obvious external injury. Rib fractures are less common; pulmonary
contusions more common.
Abdomen: The liver and spleen are proportionately larger and are less protected
by the rib cage, and therefore more susceptible to injury.
Extremities: Because bone growth is still occurring in children, long bone injuries can
result in serious disability if not managed properly. Long bone fractures and pelvis
injuries can result in blood loss that is proportionately greater than in an adult
TREATMENT
1. Support respiratory and circulatory status.
Use modified jaw thrust to open airway, administer 100% oxygen per non-
rebreather, suction; assist ventilations as needed.
Control bleeding and treat for shock.
If MAST are used, use the appropriate pediatric size; donotinflate the abdominal
compartment.
2. Provide spinal immobilization.
a. Use appropriate sized cervical collars and immobilization equipment.
If collar does not fit, immobilize with towel rolls.
When using an adult backboard, pad under child from shoulders to heels in order
to compensate for large occipital area of head. Use adequate padding to fill gaps
and voids; provide adequate immobilization.
b. Remove the child from the car seat if
The car seat is cracked, bent or otherwise damaged.
There are major injuries; i.e., full arrest, respiratory distress, serious head or chest
injury, uncontrolled bleedin
c. Use of the car seat for immobilization.
Apply a collar or towel roll to stabilize the neck and use manual in-line
immobilization.
Stabilize the thoracic and lumbar spine using towels or blankets taped in place.
Immobilize the head using towel rolls taped in place.
Secure the car seat to the cot or captain's chair facing the rear of the ambulance if
the patient is under 20 lbs and facing the front of the ambulance if the patient is
over 20 lbs. NEVER place the car seat on the bench, as car seats are not designed to
sustain lateral forces.