EMS Chest Injury

Excerpt

Emergency medical services (EMS) providers commonly encounter patients with chest injuries. Chest injuries account for nearly one-fourth of all trauma-related mortality, second only to head and neck injuries. They often require rapid intervention and stabilization, whether they are from penetrating (ie, gunshots, lacerations, punctures) or blunt (ie, motor vehicle accidents, falls, crush injury, blasts, burns) trauma. In acute trauma, an emergency medical service system aims to minimize the time between injury and medical care. Specific actions vary slightly between different systems, but the overall approaches are similar and relate to the general principles of the advanced trauma life support (ATLS) protocol.

Given the breadth and potential severity of chest trauma sequelae, rapid transport to a receiving hospital is of critical importance. Immediate interventions are occasionally necessary, but EMS providers should prioritize minimizing time on the scene. The evidence suggests better patient outcomes when invasive procedures are performed in-hospital instead of out-of-hospital.

Prehospital management often depends on the level of service of the transporting team; in the United States, this consists of essential life support (BLS) and advanced life support (ALS). Primary interventions include non-invasive airway management, cardiopulmonary resuscitation and defibrillation, hemorrhage control, spine immobilization, and splinting/stabilization of extremity fractures. More advanced techniques include advanced airway interventions (including endotracheal intubation), administration of select medications, cardiac monitoring, and needle decompression. The availability of transport services and the capabilities of destination hospitals vary significantly throughout different geographic settings, and special considerations must be taken based on local resources and facilities.