Initial trauma assessment

Pre-hospital period and its objectives

Under ideal conditions, an injured person must be instantly delivered to a specialized clinic, where they will receive comprehensive and all-inclusive medical care. However, the reality is that primary contact with the casualty most often occurs directly at the scene of the incident, where specialized personnel and equipment for full-scale diagnostics are lacking.

In standard situations (excluding mass casualty incidents), the rescue process is clearly divided into pre-hospital and hospital periods. The pre-hospital stage includes all activities outside the walls of a specialized hospital: on the street, at home, in an outpatient clinic, or inside an ambulance.

Key objectives of the pre-hospital examination:

• Save the patient's life.
• Ensure adequate function of the body's vital systems.
• Prevent the development of fatal complications that threaten health.
• Prepare the injured person for safe transportation to a medical facility.

Levels of care and diagnostics

The depth of the examination and the accuracy of the diagnosis depend on who is examining the injured person and what resources are available.

• First aid. Performed as self-care or mutual aid using simple improvised means (without medications). No diagnosis is made; response is directed at obvious symptoms.
• Pre-medical first aid. Performed by a paramedic or nurse using standard medical kits. Specialists identify life-threatening disorders and relieve syndromes, but still do not formulate a medical diagnosis.
• Primary medical care. Performed by general practitioners (general practitioners, family physicians). A preliminary diagnosis appears for the first time at this stage.
• Emergency medical care. EMS line crews do not perform fragment repositioning, surgeries, or X-rays. However, during the examination, they are obliged to establish a preliminary diagnosis prior to hospitalization.
• Primary specialized care. Provided by traumatologists in the outpatient setting using additional studies (radiography) to clarify the diagnosis.

Factors influencing the scope of interventions

The tactics of the initial examination and the scope of interventions are never a rigidly regulated template. They are determined by expediency in a specific place and time.

Five main factors:

1. Availability of medical equipment.
2. Availability of transport for evacuation to a specialized clinic.
3. Time required for transportation.
4. Qualifications of the medical worker present.
5. Number of casualties requiring simultaneous assistance.

Depending on these factors, the action algorithm changes dramatically. If an experienced traumatologist is at the scene of a traffic accident without tools, they will provide only basic first aid or pre-medical care. Wasting time formulating an exact clinical diagnosis on the roadside is pointless—it will not change the rescue tactics, but it will consume precious minutes.

If the patient is examined by a municipal polyclinic surgeon without specialized trauma training, they will provide primary medical care and immediately refer the patient to a hospital. Conversely, a physician in an isolated rural outpatient clinic, when rapid evacuation is impossible, will assume the functions of a specialized unit: they will try to make a clinical diagnosis and provide the most accessible treatment possible.

Role of the trauma outpatient clinic

The trauma outpatient clinic occupies a special place in the pre-hospital chain. It is erroneous to believe that complex reconstructive surgery can be performed here—that is the prerogative of the inpatient hospital.

Functions of the trauma center upon initial presentation:

• Conducting additional studies (primarily X-ray examinations).
• Application of therapeutic plaster casts.
• Monitoring the recovery progress and conducting rehabilitation.
• Determining indications for referral to a specialized inpatient hospital.

It is important to note that in cases of minor injuries, the trauma specialist has the authority to establish a final diagnosis and provide full-fledged treatment in an outpatient setting without resorting to hospitalizing the patient.

Briefly: answers to topical questions

Class and exam questions

What else to study on this topic

• Specifics of syndromic care at the pre-hospital stage.
• Patient triage algorithms in mass casualty incidents and disasters.
• Absolute indications for emergency hospitalization from a traumatology clinic.
• Criteria for transitioning from a provisional to a clinical diagnosis in an inpatient setting.

Other topics in the section "General Questions of Traumatology and Orthopedics"

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.