Case summary:

An ALS crew responded to 60s man who had reportedly shot himself in the head.  The crew found him in a car with two penetrating wounds to head him.  The crew confirmed that he had a pulse, but he was unresponsive.  The crew quickly extricate the patient and loaded him in their transport vehicle.  They obtained vitals while simultaneously bagging the patient and preparing to intubate. 

Vitals: BP 150/130,  HR 45,  RR 2,  could not measure a sat,  GCS 3

The crew suctioned blood from the airway and successfully passed an endotracheal tube and confirmed placement with capnography.  The crew then initiated transport and placed an intraosseous line for access.  No other injuries were identified.  Repeat vitals while in route were:

Vitals: BP 174/139,  HR 82,  O2 sat: 99%,  ETCO2: 23,  GCS 3

The crew arrived at a trauma center and handed off care to a trauma team.  The time from patient contact to wheels rolling to the receiving facility (which included intubating the patient) was 11 minutes

Highlights of the case:

Transport is the priority in trauma

Trauma patients are load and go patients with the only exceptions being airway interventions and stopping bleeding (tourniquet, pelvic binder, ect).  This is something we have emphasized in previous cases, but it is worth highlighting again due to how important this concept is.  Everything outside of airway and stopping active bleeding, including IV, full vitals, full assessment, ect, should occur after wheels are rolling to the hospital.  This is because trauma patients die of head injury and internal bleeding, neither of which we can fix in the field.  For this reason, the goal is transport to get the patient to the surgeons and blood as soon as possible.  Once this patient was extricated, they correctly delayed transport to manage the airway as quickly as possible and then immediately initiated transport.  Their on scene time was incredibly quick and they provided textbook trauma care.