3-4 TRAUMA-CHEST

Perform Initial Trauma Care per protocol.

EMR - Emergency Medical Responder

1. Perform a focused assessment of the chest, including:
   1. Visualization of chest movement
      1. Stabilize flail segment with manual pressure
      2. Do not remove impaled objects.  Stabilize in place.
      3. Treat sucking chest wound with occlusive dressing taped on 3 sides

EMT - Emergency Medical Technician  Perform/Confirm All Above Interventions

1. Initiate early transport
2. Initiate ALS Intercept
3. Apply cardiac monitor using monitoring electrodes if trained to do so.

AEMT – Advanced Emergency Medicine Tech   Perform/Confirm All Above Interventions

1. Consider ALS Intercept
2. Establish 2 large bore IVs en route, if possible.
   1. Avoid sites distal to deformities or on injured extremities.
   2. Administer a fluid bolus of 20 mL/kg up to 500 mL if the patient has a systolic BP less than 90 mm Hg. Consult medical control for further fluid orders.

Intermediate - Perform/Confirm All Above Interventions

1. Contact MEDICAL CONTROL for consideration of:
   1. Needle decompression of tension pneumothorax if indicated. If tension pneumothorax is suspected, perform needle thoracostomy by inserting a 3-5” 10-12 gauge angiocath in the 2nd or 3rd intercostal space in the mid-clavicular line on the affected side. Remove needle leaving catheter in place prior to contacting Medical Control.
   2. Administration of pain medications, if approved, utilize pain management protocol for doses and monitoring.

                          

Paramedic - Perform/Confirm All Above Interventions

1. Repeat Vital signs and if SBP < 90, repeat bolus of 500 mL NS, contact Medical Control for further fluid orders.