Management of Hemorrhagic Shock for pre-hospital providers

Depending on the patient's condition, a trauma assessment will be executed one of two ways: a standard primary survey or a rapid trauma assessment. The rapid trauma assessment is reserved for those patients who have an immediate life threat and are unstable, such as being unconscious or unresponsive. All immediate life threats are treated as they are identified during the rapid trauma assessment. The rapid trauma assessment is executed to identify massive bleeding and compromise to the airway, breathing and circulatory system.[1] It is a basic assessment that should take a minimal amount of time to complete.

The guidelines set forth by Prehospital Trauma Life Support (PHTLS) advocate for a slightly modified approach to the trauma assessment from the standard approach EMS providers are taught in their initial certification courses. This assessment algorithm is designed to address the most apparent life threats first, which is usually hemorrhage in the trauma patient. (See Table 2.)

It should be clearly understood that hemorrhage is reserved for life-threatening hemorrhage, not soft tissue injuries with non-life threatening hemorrhage. Trauma patients often have lacerations and other sources of bleeding, but they should only take precedence over airway control if they are truly life threatening.