When Is A Trauma Patient Load And Go – Help From International Trauma Life Support (ITLS)

I recently completed the International Trauma Life Support Course (ITLS) at IU Health Methodist Hospital in Indianapolis. It was an excellent course and I believe that any clinician interested in trauma care will benefit from it.

This blog is basically my study notes and my peripheral brain. Placing my notes online makes makes them available to me anywhere. And that is because the excellent built-in search function of the content management software [WordPress]  makes it easy to find my notes on any topic when I want to review them.

This post contains excerpts from International Trauma Life Support For Emergency Care Providers Provider Manual, 2016*.

* Here are links to:

Specifically, this post consists of excerpts from Chapter 2 Trauma Assessment And Management pp 28 – 49.


*Chapter 2 pp 40 +41

Critical Interventions and Transport Decisions:

When you have completed the initial assessment and rapid trauma survey or focused exam, enough information is available to decide if a critical situation is present. Patients with critical trauma situations are transported immediately. Most treatment interventions will be done during transport.

If your patient has any of the following critical injuries or conditions, transport immediately.

• Initial assessment reveals:
—Altered mental status
—Abnormal breathing
—Abnormal circulation (shock or uncontrolled bleeding*)

*Abnormal bleeding is your first priority! You should be looking for it as you approach the patient. One of your team can attend to that problem as other members of your team simultaneously address level of consciousness, airway, breathing, and circulation.

• Signs discovered during the rapid trauma survey of conditions that can rapidly lead to shock:
—Penetrating wounds of the torso
—Abnormal chest exam (flail chest, open wound, tension pneumothorax, hemothorax)
—Tender, distended abdomen
—Pelvic instability
—Bilateral femur fractures

OR Significant mechanism of injury and/or poor general health of patient. Even though the patient appears to be stable, if there is a dangerous mechanism or other dangers (such as age, poor general health, death of another passenger in the same auto), consider early transport. “Stable” patients can become unstable quite rapidly. [Emphasis Added]

If the patient has one of the critical conditions listed, after the rapid trauma survey or focused exam, immediately load the patient into an ambulance and transport rapidly to the nearest appropriate emergency facility. When in doubt, transport early.

The following procedures are done at the scene, and most of them can be delegated to team members to perform while you continue the ITLS Primary Survey: control major external bleeding, open and maintain a patent airway (position, sweep, suction; intubate if indicated and necessary), ventilate, apply oxygen, CP, seal sucking chest wounds, stabilize flail segments, decompress tension pneumothorax when indicated, stabilize penetrating objects, and maintain SMR if indicated.

Procedures that are not life saving, such as splinting, bandaging, insertion of IV lines, or even elective endotracheal intubation, must not hold up transport of the critical patient. At this point, the ITLS Primary Survey is over, and the team leader may help the other emergency care providers with patient care.

Contacting Medical Direction

When you have a critical patient, it is extremely important to contact medical direction as early as possible. It takes time to get the necessary resources such as the appropriate surgeon and the operating room team in place, and the critical patient may have no time to wait after arrival at the hospital. Always notify the receiving facility of your estimated time of arrival (ETA), the condition of the patient, and any special needs on arrival.

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