When responding to a "trauma" incident, it is important for prehospital care providers to be able to quickly determine the potential mechanism of injury, or "MOI." Trauma is either blunt or penetrating in nature. Providers must also be able to suspect or anticipate the potential injuries that may result from the MOI, which can provide insight regarding the patient's overall condition and may guide prehospital treatment.
Depending on the MOI and the injury(s) sustained, the presence of blunt trauma, such as open wounds, external hemorrhage and grossly deformed anatomy, may be obvious. Less obvious findings like crepitus or abdominal distention that are noted during the patient assessment require close attention to assessment findings.
Blunt Trauma Factors
In blunt trauma MOI, several factors must be considered. For example: In a motor vehicle collision, is the steering wheel bent? Is the steering column intact? Is there patient compartment intrusion? Was a seat belt worn? Were the airbags deployed? Is the windshield intact? Were any of the vehicle's occupants ejected (or voluntarily jumped) from the vehicle? Was an occupant of the vehicle a fatality?
In a motorcycle accident, was the operator wearing a helmet? Was the operator thrown from the motorcycle? Did the operator have to "lay the bike down"? How many people were riding on the motorcycle at the time of the accident?
Falls and assaults are additional examples of blunt trauma. In a fall, were there any contributing factors? Was the patient climbing a ladder that came in contact with power lines, leading to electrocution and a fall with subsequent blunt trauma injuries? Was the patient climbing a rock wall and fell? Was the patient attempting to commit suicide by jumping from the roof of a parking garage or building? If an assault, was a weapon used? If so, what type? A brick, baseball bat, furniture, tire iron or a bottle? Based on the assault and the weapon, what types of injuries are possible?
Penetrating trauma has different characteristics than blunt trauma. For example, the presence of an open wound on the patient's skin does not necessarily reflect the extent of internal damage. Internal injuries due to a stabbing mechanism may vary considerably in comparison to the internal injuries sustained as a result of a projectile (e.g., gunshot). In a stabbing, the internal damage may be limited to the immediate anatomy that was contacted by the object used for stabbing. In a gunshot wound scenario, the bullet (e.g. projectile) may have traveled throughout the patient's body and a variety of injuries may have been sustained.
Penetrating wounds that are located mid-thigh or higher (e.g. pelvis, abdomen, chest, axilla, neck or head) should be considered to be potentially life-threatening until proven otherwise. The reason for this is that there are anatomical structures, such as blood vessels and organs, in these areas that can create a potentially critical condition for the patient if they are traumatized. Internal injuries from penetrating trauma may present without obvious external signs and symptoms. Internal hemorrhage, organ content leakage and bone fractures are possible. From the outside, the patient may appear to be stable; internally, he may be critically wounded.
The presence of a single penetrating wound, especially in the case of a suspected shooting, should raise your suspicion. When possible, the patient should be thoroughly evaluated for the presence of a second wound. For example, if an "entrance" wound is located, look for an "exit" wound. If an exit wound (or second wound) is not located, suspect that the bullet is somewhere in the patient's body. Because it is not possible to trace the bullet within the body, assume that the patient has sustained serious injuries until proven otherwise.