7 Integrated Trauma Practice and Review
A practical guide to recognizing urgent trauma threats, giving focused first aid, and communicating changes clearly while waiting for emergency medical services.
A repeatable response to trauma
Use this sequence to organize care: check scene safety, get help, identify immediate threats, give focused care, and reassess while waiting for emergency medical services (EMS). Provide care within your training. For suspected serious injury, call EMS—911 in the United States—and do not delay the call to complete a detailed examination.
Check for traffic, fire, electricity, unstable structures, hazardous materials, and other threats. Use gloves or other available protective equipment, and do not enter an unsafe scene.
Call 911, or direct a specific bystander to call, for life-threatening bleeding, abnormal breathing, reduced responsiveness, suspected serious head or spinal injury, or major trauma. Ask another person to bring an automated external defibrillator (AED) and first-aid supplies if available.
Check responsiveness and breathing, and look for severe bleeding. If the person is unresponsive and not breathing normally, begin CPR and use an AED if available, following your training and dispatcher instructions. Control immediately life-threatening bleeding as soon as possible.
Explain what you are doing and seek consent from a responsive person. Treat the most urgent problem first. Avoid unnecessary movement if injury to the head, neck, back, hip, or pelvis is possible; move the person only when needed for safety or lifesaving care.
Stay with the person if it is safe. should follow each intervention and continue while waiting for EMS. Communicate what you observed, the mechanism of injury, care given, and changes in condition; do not guess at a diagnosis.
Control severe external bleeding
For a deep forearm wound with rapidly flowing blood pooling on the floor, and a person who is pale and dizzy, make sure the scene is safe, use gloves if available, and have someone call 911. Apply firm, continuous to the wound. If trained and equipped, use a hemostatic dressing with pressure.
If life-threatening bleeding from an arm or leg is not controlled by , apply a according to its instructions or your training. Tighten it until bleeding stops. Do not loosen or remove it, and tell EMS when it was applied.
Reassure the person and monitor their breathing, alertness, and bleeding. Recheck whether bleeding is controlled and whether the person is becoming more confused, weak, or less responsive, or their breathing is changing. Continue care and update the dispatcher if the condition worsens.
Protect a suspected fracture
After a fall, a visibly deformed lower leg with a nearby wound, severe pain, and a pale-looking foot requires an emergency call; paleness can signal impaired circulation. If bleeding is severe, control it first with . Use a for life-threatening extremity bleeding that does not stop with pressure. Once bleeding is controlled, cover the wound with a clean dressing.
Keep the leg still in the position found. Do not push exposed bone in or try to straighten the limb. Splint only if trained and able to do so without delaying urgent care or worsening pain. Keep the person still and warm.
Recheck bleeding, pain, alertness, breathing, and the color of the foot. Avoid repeatedly moving or testing the injured limb.
Respond to a head injury
A person who fell from a ladder, briefly lost consciousness, and is now awake but confused and nauseated needs an emergency call. Ask them to remain still; do not ask them to walk or move their head or neck. Do not remove a helmet unless it is necessary for CPR or airway care and you can do so safely.
Monitor breathing and responsiveness, and be ready to give CPR if needed. If vomiting or loss of responsiveness threatens the airway, follow dispatcher instructions and your training. Move the person only as much as necessary to protect breathing.
Watch for worsening confusion or headache, vomiting, seizure, vision changes, or reduced responsiveness, and report changes promptly. A person with a possible concussion should not return to sport or other activity before professional evaluation.
Minimize movement after possible spinal injury
A cyclist thrown onto the road who reports neck pain and tingling in both hands may have a . Protect yourself from traffic and call 911. If it is safe, tell the person to stay still and reassure them. Do not routinely apply a rigid neck collar or move them onto a board as a lay first aider.
If the roadway is unsafe, move the person only as necessary to reach safety, minimizing movement as much as possible. If severe bleeding or a breathing emergency occurs, address that immediate threat while following dispatcher instructions.
Continue observing breathing, responsiveness, pain, and any new weakness or numbness. Do not ask the person to test their movement.
Care for burns and possible smoke inhalation
After escaping a small kitchen fire, a person with a painful hand burn, soot around the mouth, and a hoarse voice may have an . Get them clear of smoke and danger, and call 911 because soot and voice changes may indicate .
When feasible, promptly cool the burn with clean, cool running water; cooling for – minutes may be reasonable. Remove rings or other tight items near the burn before swelling develops. Loosely cover the cooled burn with a clean, dry, nonadherent dressing or cloth. Do not put ice directly on the burn or apply creams while urgent evaluation is pending. Keep the rest of the person warm.
Watch breathing and alertness closely for deterioration. A burn larger than the person's palm, a full-thickness burn, or a partial-thickness burn of the face, hands, feet, or genitals needs prompt professional evaluation.
Prioritize care when several people are injured
At a vehicle collision, do not enter if traffic or the crash scene is unsafe. Call 911 and clearly report multiple casualties. If possible, direct a bystander to control the first person's life-threatening thigh bleeding with firm pressure; use a for uncontrolled life-threatening extremity bleeding if trained and one is available.
The second person, who reports back pain and tingling in one leg, should remain as still as possible unless the scene is unsafe. Do not spend time splinting a suspected fracture while a life-threatening bleed or breathing problem is untreated. Keep both people warm, reassure them, and follow dispatcher instructions.
Recheck each person's responsiveness, breathing, and bleeding. If more helpers arrive, assign specific tasks, such as calling 911, holding pressure, or watching the second person. Pass on changes and care already given.
Communicate and hand off care
A clear handoff helps EMS understand the injury mechanism, findings, actions taken, and changes in condition. Report observations rather than a guessed diagnosis. For example: “Adult struck by a vehicle about five minutes ago. Awake but increasingly confused; breathing rapidly; heavy bleeding from the left thigh. is being held. No movement of the neck or back. Condition is changing.”
For each practice scenario, state aloud: the hazards, the first action, who calls 911, the care and communication needed, and what you will reassess. Keep observing and report changes while waiting for EMS.