OR1.1 | Pre-hospital Trauma Care and Emergency Room Triage — Summary & Reflection

KEY TAKEAWAYS

Pre-hospital trauma care and emergency room triage follow systematic evidence-based protocols designed to address the most lethal physiological derangements first.

Key points:
- Trauma deaths follow a trimodal distribution; the ATLS system targets second-peak (minutes to hours) preventable deaths
- Pre-hospital priorities: scene time ≤10 minutes (platinum ten), airway, haemorrhage control, rapid transport
- START triage classifies patients into Black/Red/Yellow/Green using respiration, radial pulse, and mental status in mass-casualty incidents
- The ATLS primary survey follows ABCDE: Airway (with C-spine), Breathing (tension pneumothorax), Circulation (haemorrhage control), Disability (GCS/AVPU), Exposure
- FAST ultrasound, chest X-ray, and pelvic X-ray are the primary-survey adjuncts; CT is reserved for haemodynamically stable patients
- Damage control resuscitation uses 1:1:1 blood product ratios, permissive hypotension (SBP 80–90 except in TBI), and tranexamic acid within 3 hours
- Femoral shaft fractures can lose 1–2 L of blood; open-book pelvic fractures can lose 2–4 L — apply pelvic binder at the greater trochanters
- Open fractures: IV antibiotics within 1 hour, photographed and covered once, debridement as soon as feasible
- The 6-hour rule for open-fracture debridement is obsolete; antibiotics are the time-critical intervention

REFLECT

Consider a scenario where you are the medical officer at a primary health centre and you receive a call that a tractor has overturned, injuring four farmers. The centre has no blood bank, no orthopaedic surgeon, and the nearest district hospital with a surgical facility is 45 minutes away. Which of the ATLS principles remain applicable? What improvisations would you make for a pelvic binder? At what point would you activate the district disaster management plan? How does this scenario change your understanding of what 'adequate' pre-hospital care means in resource-limited settings? Discuss with a peer and note what gaps in your training you would want to address before your rural posting.