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KEY POINTS

KEY POINTS

  • The goal of the initial assessment is the rapid identification and treatment of life-threatening injuries.

  • Structured handoffs from EMS improve communication to the trauma team.

  • The resuscitation bay should contain all instruments and equipment required in a major trauma.

  • Trauma team composition should have sufficient personnel to both assess and treat the severely injured.

  • The team leader should be the most senior person on the team with an understanding of injury.

  • Coordination of care by the team leader is crucial to successful trauma assessments and resuscitation.

  • The initial assessment should follow the standard primary and secondary survey algorithms as outlined in Advanced Trauma Life Support (ATLS).

  • Patients who arrive in shock require even more rapid assessment and treatment by the most senior personnel.

  • Initiating the resuscitation with intraosseous access can be lifesaving in patients in shock.

  • Early arterial access for subsequent resuscitative endovascular balloon occlusion of the aorta (REBOA) deployment should be considered for patients presenting with subdiaphragmatic life-threatening hemorrhage.

INTRODUCTION

The importance of the initial trauma assessment cannot be overstated. Missed or delayed identification of injuries during the initial assessment can lead to significant morbidity, complications, and even death. Although there have been multiple studies demonstrating the effectiveness of trauma center care on outcome, in reality, the optimal approach to a trauma patient should be universal regardless of the center. Prompt evaluation and treatment are cornerstones of modern trauma systems, which all starts with the initial assessment.

The initial assessment begins with an understanding of which patients need an evaluation by a trauma team. After successful field triage (see Chapter 4), the injured patient should be seen in a setting that can accommodate the necessary equipment and personnel to provide high-quality trauma care. The basic principles of Advanced Trauma Life Support (ATLS) are used with the primary goal of rapidly identifying and treating life-threatening injury. Adjunctive diagnostic modalities such as a chest radiograph or focused assessment of sonography in trauma (FAST) are often employed to help with the assessment. Finally, ongoing evaluation with feedback and training of the trauma team is needed to maintain readiness.

TRIAGE

Although trauma can be easily defined as “injury,” the patient with an injury requiring the resources and expertise of a trauma team is less clear. The ability to triage or “sort” trauma patients to the appropriate level care can be examined from several different aspects. These include (1) prehospital triage (ie, does this patient require a trauma center?), (2) trauma center designation (ie, in a region where there are several levels of trauma centers, which one is most appropriate?), and finally (3) in-hospital triage tiered response (ie, who is going to see and treat the patient upon arrival?). The best outcomes will be generated by a system that is seamlessly connected.

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