Pre-hospital trauma care is a rapidly developing specialty, combining clinical skills with rescue safety principles.
⚠️ Safety first: Rescuer safety always precedes patient care.
Framework: MARCH (Massive haemorrhage → Airway → Respiration → Circulation → Head/Disability).

🚨 Arrival at the Scene

🚗 Position vehicle to protect the scene & warn other traffic (beacons/lights).
👷‍♂️ Safe exit & hazard check before approaching patient.
🦺 PPE: fire-retardant overalls, boots with toecaps, gloves, helmet, and eye protection.
🔥 Liaise with fire service to make the scene safe before patient contact.
🔍 "Read the wreckage": mechanism of injury predicts likely trauma pattern.
📡 Early communication → mobilises resources faster.
🚻 Triage if multiple casualties: prioritise based on physiology and survivability.
🚒 Fire service may be needed for access/extrication planning.

🌟 Exam Pearl: In major incidents, use Sieve & Sort triage. Immediate priority = airway obstruction, catastrophic haemorrhage, or compromised breathing.

🩸 Primary Survey – MARCH

M = Massive Haemorrhage
- Direct pressure → elevation → indirect pressure → wound packing → tourniquet → haemostatic agents.
- Chest/abdominal bleeding ➝ rapid transfer to hospital (prehospital control not possible).
A = Airway + C-spine
- Manual in-line stabilisation (jaw thrust, avoid head tilt/chin lift).
- Adjuncts: oropharyngeal/nasopharyngeal airway, supraglottic device if trained.
- Definitive: Intubation if feasible.
- Rescue: Surgical airway (scalpel–bougie–tube or Melker kit) if unable to ventilate.
R = Respiration
- High-flow O₂ as soon as safe.
- Seal open/sucking chest wounds.
- Needle decompression (2nd ICS mid-clavicular or 5th ICS anterior axillary) → chest drain.
- Reassess RR, SaO₂, trachea, percussion note, chest expansion.
C = Circulation
- IV/IO access (do not delay transfer for IV attempts).
- Permissive hypotension: Titrate fluids to palpable radial pulse (or carotid in chest trauma).
- 250ml boluses isotonic saline if shocked. Prefer blood products if available (MHP).
- Target higher BP if head injury (maintain CPP).
H = Head / Disability
- Assume C-spine injury until excluded → collar + blocks + tape.
- Rapidly reverse hypoxia & hypotension.
- Agitated/unconscious ➝ secure airway, prevent aspiration.
- Transport urgently to neurosurgical centre.

👥 Trauma Team Activation Criteria

SBP < 90 mmHg
RR < 10 or > 30
GCS < 12 with torso/extremity trauma
Pregnant > 20 weeks with abnormal foetal HR
Amputation proximal to elbow/knee
≥2 proximal long bone fractures
Suspected spinal cord injury
Severe airway-compromising maxillofacial trauma
Burns > 15% TBSA
Gunshot proximal to knee/elbow or trunk/head/neck
Ejection from vehicle / pedestrian thrown
Fall > 6 m
≥3 major trauma patients arriving simultaneously
Or: Emergency doctor judgement

📝 Key Principle: In trauma, fix what kills first. Control haemorrhage, oxygenate, decompress chest, then stabilise for transfer. Definitive care is in hospital.

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Trauma:Prehospital

🚑 Introduction

🚨 Arrival at the Scene

🩸 Primary Survey – MARCH

👥 Trauma Team Activation Criteria

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