When a patient is injured, it's up to the paramedics to determine if the patient is injured badly enough to call "a trauma" or not. If they believe he is potentially severely injured, he comes to me. Not bad enough, he goes to the ER to see an ER doctor, and if that person finds injuries that need further care, he consults me.
In trauma we follow certain protocols. It helps us avoid mistakes and it bails us out of innumerable problems. The major protocol couldn't be easier to remember: ABCDE.
A: Airway. Secure the airway, #1 priority, always.
B: Breathing. Is the patient doing it? If not, do it for him.
C: Circulation. Is the patient's heart beating? If not, do it for him.
D: Disability. What's the neurological status?
E: Exposure. Completely disrobe the patient and look for hidden injuries.
You always start with A and you do NOT move on until you're satisfied it's ok. If the patient isn't responding to your treatment appropriately, start back at A and figure out what you missed.
Easy, right? Well...not so much for some people, mainly ER doctors in my observations.
A few weeks ago I had a STAT consult from an ER doc on a patient with multiple stab wounds. Though I was already attending to 5 other seriously injured victims, I immediately ran to the main ER to see a very calm-looking man lying quite comfortably on his stretcher with his right arm and left leg nicely bandaged. Turns out he was stabbed in a bar fight, but no one had looked at his wounds yet.
I unwrapped his arm and leg and found three tiny 1cm stab wounds, none of them bleeding. At all.
I called the ER doc over and asked her if she had evaluated the wounds yet. "No, I just heard multiple stabbings and I called you."
Right. Like I wasn't busy enough.
Apparently to her, the protocol is:
C: Consult trauma surgeon