The following is a document that was crafted from years of discussions between Trauma Surgeons, EMS Physicians, and Paramedics to determine what would be the ideal approach to trauma in the prehospital setting. The document is never considered complete and is under continual review and improvement.
Denver EMS Approach to Trauma
Original Release July 2022
Approved by Medical Review Board
Updated July 2022
Statement of Why
Denver Health Paramedics have a proud reputation for running critical trauma exceptionally well. This is due to quick scene times, command of the scene, executing skills, and getting the patient to the appropriate trauma center. We have historically measured our success by our short scene times alone. As the teamwork between Denver 911, Denver Fire Department, and the Denver Health Paramedics has strengthened, and the use of data is more advanced, we have matured to the point that our perspective on trauma should continue to evolve. By reassessing the priorities of our tasks and decisions, we can better manage our calls while delivering the best care for our patients.
By analyzing multiple outcome-associated metrics across the continuum of care, we can establish baselines, compare ourselves to other agencies, reassess and continue process improvement, and assess our care directly related to patient outcomes. Ultimately, we should not measure our success only in on- scene times; the total time from Call Pick-Up to Arrival at ED and whether or not we provide the appropriate care for our patients matters more. The small refinements will strengthen an otherwise very strong-link process. Being the best should never stop us from striving to be better.
Six Phases of a Trauma Call
Phase I: All Activity from 911 Activation to 1st First Responder on Scene
Determine Nature of Call
Identify potential number of patients Identify Safety Concerns
Identify Locations of Patient(s)
Phase II: All activity from 1st First Responder on Scene until the Patient is loaded in an ambulance
Consider Ingress/Egress and position of vehicles Identify all patients
Triage the scene
Addition Resources Assessment
Stop Major Bleeding
BLS Airway Management Package to load the patient Set-up Ambulance
Phase III: All activity between patient loaded in ambulance and ambulance leaving for ED
Other priorities without inappropriately delaying transport (Ideally <90 seconds) 1st IV Attempt
Trauma Expose the Patient
Initial Assessment, Identify Life Threats, Treat Life Threats
Phase IV: All activity while transporting the patient
Airway/Respiratory Management Biophone call
Repeat Vital Signs
Other tasks/skills as appropriate Package patient for delivery to ED
Phase V: All activities once patient is at the hospital until care is in ED hands
Deliver patient to assigned room
Brief if trauma arrest, and clear patient for ED interventions
Management of Multiple Patients
Phase VI: Activities involved in personal and system improvement
Peer Debrief (partner, student, Command)
Peer Review – QA
MRI Review Committee
Principles of Trauma
Ideal trauma care consists of 3 major components:
Highly trained, excellent providers (quality)
Rapid assessment and treatment (speed)
High functioning system of care (teamwork).
Hemorrhage control is a top priority
Tourniquets should be used on all extremities with life-threatening bleeding.
Direct pressure and / or wound packing take precedent over other tasks and should not be interrupted.
NS 500cc boluses
Suspicion of head injury SBP below 100
No suspicion of head injury SBP below 80
Unlike a medical arrest, the number one priority is rapid treatment and transport to definitive care.
Chest compressions should be done unless a higher priority action is indicated and resources limit what tasks can be performed.
The following actions/assessments are of higher priority than uninterrupted chest compressions. Examples in no particular order: