What to do until medical arrives: Blunt trauma

Whether a fight in the yard, a fall down the steps in the tiers, or a take-down that gets out of hand, blunt trauma is a common emergency situation in a correctional facility

During morning showers, in a two-level housing unit, three inmates engage in a shoving match near the top of the stairs resulting in one of the men falling over the railing to the concrete floor below. He lands on his back and does not get up. A man-down is called and inmates are returned to their cells while the area is secured for medical team arrival. Does this scenario sound like it could happen at your facility? 

A number of medical emergencies can arise in a jail or prison. That is why it is handy to have health care staff available to respond and treat life threatening conditions. Depending on the location of the man-down, however, it may take a while for medical staff to arrive. 

So, it is important to know what to do in the early stages of any medical emergency. This is part of a series to help corrections officers manage medical emergencies until health staff arrive to provide definitive care. I made a list of the common emergencies officers may encounter in the course of a shift. In this installment I discuss blunt trauma.  

Whether a fight in the yard, a fall down the steps in the tiers, or a take-down that gets out of hand, blunt trauma is a common emergency situation in a correctional facility. Unlike penetrating trauma where a shank or other instrument tears a hole in the body, blunt trauma results from a significant force upon the body that then causes unseen internal injury. Though blunt trauma can sometimes cause open, obvious wounds the danger of blunt trauma injury is that it can be invisible and therefore undetected. 

What’s Going On: Hidden Dangers
The two major hidden dangers of blunt trauma are broken blood vessels that lead to internal bleeding and broken bones that can lead to malfunctioning life-sustaining body systems like breathing. Combined with these two is tissue swelling, a normal physiologic response to injury. Swelling can squeeze internal spaces to the breaking point and compromise life-sustaining functions like breathing, sensation and movement. 

Blunt trauma can happen in any area of the body. Legs and arms are common locations, and bruising or broken bones are the frequent results of major forces on these appendages. They are painful and need attention in order to reduce that pain and treat any fractures. However, the most dangerous type of blunt trauma occurs to the head and trunk as these can be life-threatening; requiring fast action by first responders.

What to Be Concerned About
Blunt trauma concerns depend on the body part involved. Arm and leg involvement may mean broken bones or muscle/tendon injury. Head and trunk injury can be more serious.

•    Head: Bleeding or swelling inside the skull can lead to pressure on brain cells causing tissue death. Depending on the area of the brain, this damage can shut down breathing and heart innervation or cause movement or speaking difficulties.
•    Chest: Upper trunk trauma can cause difficulty breathing or bruise the heart causing circulation problems. Bleeding into the chest cavity can also decrease circulation volume. The accumulating blood can lead to difficult, shallow breathing and pressure on the heart muscle.
•    Abdomen and pelvis: Lower trunk trauma can lead to bruising of the kidneys, liver, or spleen. Bleeding into the abdomen and pelvic cavity can also decrease circulating volume and quickly lower blood pressure.

What to Do Until Medical Arrives

•    While medical staff are en route to your location with equipment and medication, keep focused on the basics — airway, breathing, and circulation. In particular, loosen any restrictive clothing that may be impairing breathing. Patients with chest trauma may be more comfortable sitting upright or self-splinting their injured ribs with their own hands. 
•    Always consider the chance that the spinal cord or column was injured and avoid moving the patient until a cervical collar is placed to stabilize the neck. 
•    Talk to the victim to determine mental capacity. If the person is unconscious, try to arouse them with a gentle shake and a shout close to their face. If they arouse, keep them talking to determine mental capacity. If they do not gain consciousness, check for a pulse. If the patient doesn't have a pulse or signs of life initiate CPR until the medical team arrives.
•    Once medical staff arrives, establish who is in charge of the team and relay information about events that precipitated the injury and actions taken thus far. Assistance may be needed to transport the victim to the medical unit or emergency room.

Have you had to manage a blunt trauma the medical until arrives? Share your story in the comments section of this post.

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