ABCDE Approach:

Algorithms are helpful to improve survival outcomes for Pre-hospital management in severe patients
(Tueben et al. 2019)

(Thim et al. 2012) & the Resus Council explains the more details on what to look for on each ABCDE
algorithm assessment and treatment

Maschmann et al. 2019 suggested stabilisation of Cx before checking response

Marshall 2017 shows DRABCDE is better than ABCDE approach

Johnson 2023 suggested the 5 areas are signs of catastrophic haemorrage

2015 American Heart Association and European Resuscitation Guideline suggest each CPR
compression should be at least 5cm and less than 6cm

Schmicker et al. 2021 show 30:2 is better than chest compressions if done correctly

Goyal et al. 2022 shows how the first 30 seconds of the CPR did to the casualty

Zemaitis et al. 2023 shows only start secondary survey when casualty shows ROSC and explanation
for the head to toe examination

Planas et al. 2022 explain the procedure of checking circulation, disability and exposure in primary
survey post trauma

Sujan et al. 2013 on the importance of filling in ATMIST and SAMPLE to pass on across care
boundaties

AVPU Scale:

➢ Romanelli & Farrell (2023) suggested that it is quick and simple way to detect altered mental
status, primarly used in trauma and first aid. As a decreased mental status could indicate
inadequate circulation of oxygenated blood to the brain.
➢ can be monitored in situations where player breathing but unconscious & unresponsive.

Pupillary Light reflex:

➢ Dooley (2011) mentioned the Testing the ANS of the brainstem and check for potential
brainstem injury
➢ Planas et al. (2023) said GCS <8 indicated the patient may have reduced airway reflexes
making them unable to protect their airways

Cardiac Arrest

➢ Kleinman et al. (2010) mentioned paediatric cardiac arrest mainly happen due to respiratory
failure, while it is usually cardiac issues in adults. That’s why 5 initial rescue breath for
children.
➢ De Jong et al. (2019) provides S&S on how to look for sudden cardiac arrest on the field, from
7 seconds start losing consciousness and 36 to 120 seconds start stopping to breath
CPR

➢ After cardiac arrest a combination of basic and advanced airway and ventilation techniques
are used during cardiopulmonary resuscitation (Newell et al, 2018)
➢ The main difference between normal Adult Life support and Advanced
➢ Idris 2012 suggested that 100-120 compression per minute is optimal blood flow
➢ Giberson et al. 2016 on the 4 reasons to stop CPR
➢ Vogt 2020 suggested that BVM is better to have 2 rescuers

AED

➢ Ventricular Fibrillation (VF) and Pulseless Ventricular Tachycardia (VT) are shockable rhythms
➢ Pulseless Electrical Activity (PEA) and Asystole are non-shockable rhythms
➢ Casualties in a shockable rhythm have an increased chance of survival

(Zhang et al. 2020)

Sudden Cardiac Death

➢ S & S to look for (Yow et al. 2022)

Causes of upper airway obstruction

➢ Oxford Textbook of Medicine (6 edn)

➢ Kim et al. 2013 - reduced central respiratory centre neural activity leading to relaxed
musculature, mainly occur at oropharynx
➢

Laryngeal Trauma

➢ Shaker et al. 2023: S & S to be aware of

Indications and Contraindications for Naso and Oraphaygreal airway

➢ Kim et al. 2013

➢ Sharder et al. (2017) water-based jelly to lubricate I-Gel
➢ Brown et al. 2020 explains the rationale for the airway management
➢ Castro and Freeman 2023 showed importance of putting airway in unconscious patients but
only on unconscious casualty to avoid vomiting or laryngospasm may occur if
glossopharyngeal or laryngeal reflexes are present

Effectiveness of IGEL:
 ➢ Theiler et al. (2012) – proved to be effective supraglottic device - a high overall insertion and
ventilation success rate of 96%,

Scanning for potential myocardial infarction:

➢ American Heart Association (AHA) and American College of Cardiology (ACC) (Maron et al
2007) about the pathology of the 5 cardiac problems
➢ Jouven et al. (2017) S&S should remind them to be aware
➢ Bille, K., Figueiras, D., Schamasch, P., Kappenberger, L., Brenner, J.I., Meijboom, F.J. and
Meijboom, E.J.(2006) Sudden cardiac death
➢ in athletes: the Lausanne Recommendations. European Journal of Cardiovascular
Prevention and Rehabilitation 13(6):859-875.
➢ Basso, C. and Corradoon, D on behalf of the Sport Cardiology Section of the EACPR of the
ESC (2016) Sudden cardiac arrest in
➢ sports – need for uniform registration: A position paper from theSport Cardiology Section
of the European Association for
➢ Cardiovascular Prevention and Rehabilitation. European Journal of Preventive Cardiology
23(6):657-667

Traumatic Brain Injury:

➢ Menon et al 2010 and Dawodu, 2013 shows the definition

➢ However, females have higher rates of concussion in sports that have similar rules of play
➢ between sexes (such as soccer or basketball) (Master et al 2018)
➢ Prien et al. 2018 shows mens rugby, mens American football, women ice hockey, and soccer
are most common occur of injury amongst all contact sports
➢ Dreier 2011 proprosed a term for brain contusion injury - diffuse axonal injury (DAI) &
complex neurometabolic changes for acute/chronic S&S
➢ S&S of concussion – Ferry & Decastro 2023
➢ Protocols for RTP after concussion: McCory et al. (2011), 6 step procedure with initial rest ½
days, 24 hours between each step
➢ Tator 2013 showed the prognosis for the S&S resolved in minutes to hours
➢ Al-Obaidi et al. 2019 mentioned A slow pupil response to light may be a sign of brain injury
(increased intracranial pressure or ICP)
➢ According to NHS guideline, if they LOC, headache not gone away, vomit, change in
behaviour, visit A&E
➢ Signs of skull fracture and penetrating head injury – NICE Guideline 2014
➢ May et al. 2023 about Secondary Impact Syndrome
➢ Theedom et al. 2023 suggested the factors lead to severity of subsequent concussion and
could be cumulative
➢ Chronic traumatic encephalopathy – Inserra et al. 2023 – associated with repeated TBIs
➢ Cifu (2014) suggested repeated Traumatic brain injury will increased risk of later-life cognitive
impairment and neurodegenerative disease especially with repeated injuries

Scat 5 assessment:
 ➢ Fuller et al. 2021 showed it is effective to use on pitchside – sensitivity 95%

Maddocks 1995

➢ assess orientation & short term memory – time, day, place

➢ McCroy et al. 2005 mentioned Maddocks more easy and less time consuming then other
neuropsychological testing

Spinal Cord Injury:

➢ Definition - Sports Medicine Australia, 2013

➢ Ding et al. (2022) mentioned fall from height and road traffic accident is most common
happen.
➢ Fuller et al. 2007 showed rugby player at highest risk
➢ Singhal & Aggarwal 2011 – definition of spinal shock,
➢ Ziu & Mesfin 2022 – definition of Quadriplegia and Paraplegia
➢ MOI: Sports Medicine Australia, 2013
➢ Heffernan et al. 2005 distracting injury
➢ Chang et al. 2002 on the NEXUS criteria for distraction injury: long bone fractures, visceral
injuries, large lacerations, degloving or crush injuries, large burns, or any other injuries that
distract the patient from cervical spine pain
➢ Micallef et al. (2012) mentioned Canadian C Spine is more accurate and higher sensitivity
than NEXUS
➢ Norwegian guideline for pre-hospital management in acute spinal cord injury (transfer to
stretcher using scoop transfer)
➢ Hauswald et al, 1998 help prevent secondary injury/excessive movement
➢ Dave at al. 2023 Neurogenic shock will require vasopressor to bring the BP up and Atropine
for Bradycardia

Chest Trauma:

➢ Jain & Waseem et al. 2023 – hypoxia is the main problem, MOI include direct contact to
chest, penetrate by object, rapid deceleration force, rupture blood vessels
➢ Newton First law of motion – equilibrium force to stop
➢ Joules = ½ Kg x M/S
➢ Kostiuk & Burns 2023 – red flags S&S for chest injury
➢ Lee et al. 2007 – sitting up is best position if only chest injury
➢ The pre-hospital management of chest injury: a consensus statement” was published by the
Faculty of Prehospital Care, Royal College of Surgeons of Edinburgh in 2007. – The life
threatening condition of chest injury
➢ Ludwig & Koryllos (2017) on management of chest injury
➢ Chauncey & Wieters 2023 - Tranexamic acid to control heavy bleeding
➢ Levy et al. (2023) suggested analgesia to reduce blood pressure and HR if tachycardia while
vasopressors for hypotension to limit further dissection before surgery
Wound Management:

➢ The Molecular and Cellular Biology of Wound Repair 2012

➢ Palti et al. (2009) – any bites breaching epidermis require antibiotics.
➢ Dowsett (2008) on the TIME Framework for wound management – tissue management,
control infection, moisture control, close epithelial edge. How deep to the tissue? Refer to ED
immediately if hypodermis and dermis with concern, rapid welling, heavy contaminaton,
uncontrollable bleeding, irregular edges require surgery to close
➢ Wounds International (2019) for details explanation for each step: leave or close no damage,
early decontamination, golden 6 hour closure, volume of fluid,
➢ Hatamabadi et al. 2015 mentioned celox is more effective than pressure bandage
➢ Minor Emergencies (Third Edition) 2012 - Wound closure tapes (Steri-Strips) and tissue
adhesives offer the lowest risk for infection and are most successfully used on simple
superficial lacerations with minimal tension. Must use on clean and dry wound
➢ Dirty wounds e.g with exudate – Inadine/gauze/bandage max 72 hours (Sibbald & Elliot et al.
2017)
➢ Silicone dressing for exudate wound to pass through avoid infection.
➢ Suspected Infectious disease according to NHS guideline: vaccinated against tentanus? Soil in
wound, high fever, breathless, palpitations
➢ Hydrocolloid dressing provide moisture environment and granulate for tissue formation Total
Burn Care (Fourth Edition), 2012, mainly used in abrasions, act as a barrier against external
bacteria.

Management for Hypothermia:

➢ Haverkamp et al. 2018: the best way to manage hypothermia in a prehospital setting is to
reduce further heat loss by placing the patient in a warm and dry environment and applying
insulation in combination with a vapor barrier. Heat packs, blanket and hooded sleeping bag
if not warm up.
➢ (Duong & Patel 2022) Pathophysiology: the most common mechanism of developing
accidental hypothermia is by convective heat loss to cold air and when in cold water or wet
clothing via immersion or excessive sweating. Below 35 degree is mild
➢ When the temperature drops and affect the metabolic, neurologic, respiration, causes
reduce workload in organs. Lead to atrial fibrillation
➢ Glucose too

Management for Hyperthermia:

➢ Daniel (2021) definition of exertional hyperthermia is >40

➢ Resting casualty under shade
➢ Cold water immersion is optimal technique - the thermal conductivity of water is 24 times
greater than air.
➢ Wrapping a cold wet towel around
➢ Spraying the victim with water and fan
➢ Rehydration of oral and intravenous cold drinks and electrolytes
➢ Heat stress causes lost of salt and water, increasing risk of coronary and cerebral thrombosis,
also increase workload to the heart (Keatinge 2003)
Strapping:

➢ Basic rationale is to provide protection and support for an injured part whilst permitting
optimal functional movement (Austin, Gwynn-Brett, Marshall, 1996).
➢ Cupler et al. (2020) – allowed early controlled activity, control swelling, proprioceptive
feedback.
➢ Pre & Post Taping Consideration guideline (Austin, Gwynn-Brett, Marshall, 1996) – VAS 2/3
out of 10 – Avoid premature participation, seek expert opinion, monitor circulation, do not
apply ice beforehand,
➢ Zinc Oxide for non-contractile tissues, Elastic Adhesive Bandage for contractile tissues,
Balsam (Vicenzino 2000)

Peripheral Injuries:

➢ Teenagers more prone to fracture than adults (Aygun 2020)

➢ Coleman (2018) S&S for fracture
➢ Diagnosing fracture pitch side with tuning fork (Toney et al. 2016) & (Mugunthan et al, 2014)
mentioned it has some value on rule out fracture.
➢ (Heyworth 2003) almost 100% sensitivity for Ottawa Ankle Rules b4 require X-Ray – midfoot
and malleolar zone – check for tenderness.
➢ Lee & Porter (2005) pre-hospital management of lower limb fracture, straighten limb, if
possible, splint, call para only if unable to immobilise or vascular compromise
➢ Journal of Orthopaedic Trauma – signs of dislocation
➢ Fennelly et al. (2020) - Stimson Manoeuvre – reduction in 25 minutes of shoulder dislocation
➢ PEACE & LOVE guideline for soft tissue injury first aid