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TRAUMA CARE as obvious signs of trauma?2–4,26–29 When assessing a trauma victim, a rapid assessment to identify life- threatening injuries is essential. Critical interventions may include airway management, thoracic decompression, application of direct pressure for external hemorrhage, and avoiding on-scene delays before beginning rapid transport to the closest appropriate facility.2–4,26–29 A rapid patient assessment can be completed in less than 60 seconds. Providers can perform this using the acronym ABCDE (for airway, breathing, circulation, disability and exposure).2–4 These components can often be performed simultaneously. For example, after opening the patient's airway, it is not necessary to pause for 30 or 45 seconds to assess the patient's breathing before determining what intervention to consider. Rather, once the patient's airway is opened, their respiratory quality, effort and effectiveness can be quickly assessed. After exposing the patient, apply covers or blankets to help main- tain their body temperature. Providers can also simultaneously begin to deter- mine the next sequence of steps for both assessment and treatment. A variety of tools can be used to assist with the rapid assessment, including capillary refill time, the AVPU mnemonic (alert, verbal, painful, unresponsive) and Glasgow Coma Scale score.2–4,26–29 FOCUSED ASSESSMENT Following the initial rapid assess- ment, the provider should perform a more detailed, or focused, head-to-toe assess- ment when time and patient condition allow. This should begin with visual inspection, followed by hands-on assess- ment. This includes noting the presence of DCAP-BTLS: deformity, contusion/crep- itus, abrasions, penetrations/paradoxical movement, burns, tenderness, lacerations and swelling. Life-threatening situations, such as tension pneumothorax, should be managed immediately in accordance with local protocol. Examine the patient's head, neck, chest, abdomen and extremi- ties. Any abnormal findings should be suspected as indicative of traumatic injury.2–4,26–31 If time permits, obtain a detailed medical history. This can be accom- plished using the SAMPLE approach: signs and symptoms, allergies, medi- cations, past medical history, last meal eaten and events leading up to this episode. Additional questions may include: What (if any) events occurred prior to this episode? Has this episode remained consistent since onset, or has it varied? Has anything relieved the symp- toms? Has the patient taken any medi- cations? Is there a report of alcohol or substance abuse? If the patient is female, Enjoy the beneƥ ts of membership The National Association of Emergency Medical Technicians (NAEMT) is the only national association representing and serving all EMS practitioners — and membership offers valuable programs, services and discounts, including: $125 off EMS World Expo and a free subscription to EMS World Magazine A signi⇒ cant members-only discount off select 5.11 Tactical, Inc.™ merchandise Learn more at www.naemt.org, membership@naemt.org, or 1-800-346-2368. $10,000 in AD&D; insurance coverage FREE and discounted EMS online continuing education Discounts of up to 30 percent on EMS products and services ...and much more! For More Information Circle 33 on Reader Service Card EMSWORLD.com | FEBRUARY 2012 49