6 Multisystem Trauma

Understand multisystem trauma

A serious event may injure several parts of the body at once. A visible fracture or burn can occur alongside a less obvious, life-threatening problem such as internal bleeding or a blocked airway. Treat immediate threats to life first; do not let a less urgent injury distract from them.

This guidance is for bystanders and is not a substitute for emergency medical care or hands-on training.

Prioritize immediate threats

1. Make the scene safe. Do not enter an unsafe area, including one with traffic, fire, electrical hazards, chemicals, or violence. Use gloves or another barrier if available. Ask someone to call 911 and bring an AED or first-aid kit. Give the dispatcher the location, hazards, and number of injured people, and follow the dispatcher’s instructions.

2. Control life-threatening external bleeding. Apply firm, steady pressure directly to the wound. For life-threatening bleeding from an arm or leg, use a tourniquet if available and you are trained. Pack a wound only if trained. Do not remove an embedded object; apply pressure around it.

3. Check responsiveness and breathing. If the person is unresponsive and not breathing normally, begin CPR and use an AED if available, following your training and dispatcher guidance. If there is more than one responder, one can continue bleeding control while another assists with breathing or CPR.

4. Look for shock or hidden injury. Serious trauma can cause internal bleeding without an obvious wound. Call 911 for suspected shock or major trauma. Keep the person comfortably warm, reassure them, and do not give food or drink.

Protect other injured areas

Once immediate threats are being addressed, avoid unnecessary movement and provide only simple care within your training.

Head, neck, or spine injury

Suspect injury after a high-impact event or a fall, or when the person has head, neck, or back pain, confusion, weakness, numbness, or tingling. Ask them to stay still. Do not move them unless necessary for safety, CPR, or urgent care. Tell the dispatcher immediately if they become less alert, have a seizure, repeatedly vomit, or develop worsening confusion or weakness.

Fractures

Treat a painful, swollen, deformed, or open injury as a possible fracture. Do not straighten the limb or push protruding bone back in. Leave it in the position found, control bleeding around the wound, and watch for numbness, tingling, or changes in color or temperature below the injury. Pelvic, upper-leg, or multiple injuries warrant urgent EMS care.

Burns

First make sure the heat, electricity, or chemical hazard is no longer dangerous to approach. For a thermal burn, cool the area with clean, cool running water if doing so will not delay care for a more urgent threat. Remove jewelry or loose clothing, but not material stuck to the burn. Do not use ice, butter, or ointments. Large, deep, facial, chemical, electrical, or breathing-related burns need urgent medical attention.

Reassess and coordinate care

A person’s condition can worsen, and serious problems may become clearer over time. Stay with them and repeatedly recheck responsiveness, breathing, and bleeding, especially after any change or first-aid action. If breathing becomes abnormal, bleeding restarts, or alertness declines, tell the dispatcher and act within your training. Keep the person still and at a comfortable temperature; do not leave them alone.

When EMS arrives, give a short, factual handoff:

• What happened: the mechanism and approximate time of injury.

• What you found: major injuries and changes in breathing or responsiveness.

• What you did: pressure, tourniquet, CPR/AED, burn cooling, or other first aid, including when it was done.

• What you know: relevant symptoms, allergies, medications, or medical conditions, if available.

Follow responders’ directions and point out hazards, witnesses, and any injuries that may be hidden. Clear communication helps responders continue care without interruption.