Major Trauma
Major trauma is a circumstance of a single cata-
strophic injury, such as GUNSHOT WOUNDSor BURNS,
or multiple injuries that affect multiple body sys-
tems in such a fashion that without urgent med-
ical intervention death is likely. Major trauma
most often results from events such as MOTOR VEHI-
CLE ACCIDENTS, fires, serious falls, occupational
accidents, and other situations in which the body
encounters multiple hazards. Situations of major
trauma are often more than an individual first
responder can adequately assess. The top priority
of FIRST RESPONSEis to get emergency personnel
and equipment to the scene and prevent further
injuries to the person or to others who are
involved in the situation or arrive at the scene.
blunt trauma Injury that results from a strong
blow or force. The injury may not be initially
obvious because there may be no outward signs
such as LACERATIONSor bruises. However, blunt
trauma may cause internal bleeding or rupture of
upper abdominal organs such as the SPLEENor PAN-
CREAS. Blunt trauma to the head may cause TRAU-
MATIC BRAIN INJURY(TBI).
Site and situation assessment MOTOR VEHICLE
ACCIDENTS, industrial accidents, and collisions with
stationary objects (such as a skier running into a
tree) are among the situations that may result in
multiple trauma.
Responder personal protection measures Latex
gloves, which the responder should put on before
approaching the injured person, are essential for
personal protection from the possibility of acquir-
ing INFECTIONthrough contact with body fluids.
First response actions There are few FIRST
RESPONSEmeasures for blunt trauma beyond keep-
ing the injured person still and calm. SHOCKmay
be the only indication of internal bleeding from
blunt trauma, which can be serious enough to
cause rapid death. Surgery is the only means to
treat internal bleeding.
Follow-through A health-care provider should
evaluate blunt trauma to determine the need for
further treatment.
See also CLOSED FRACTURE; SYMPTOM ASSESSMENT
AND CARE TRIAGE; SITE AND SITUATION ASSESSMENT;
SYMPTOM ASSESSMENT AND CARE TRIAGE.gunshot wounds Injuries that result from bul-
lets. Gunshot wounds are often more serious than
they appear, particularly when the bullet remains
lodged in the body. A bullet enters the body with
high velocity and follows a trajectory of least
resistance. That trajectory may carry the bullet on
a direct path through soft tissue or along the path
of a BONE. Gunshot wounds may be accidental or
intentional, self-inflicted or inflicted by another
person.Do notapproach a person who has a
gunshot wound or the site of a shooting
if there is still gunfire or the where-
abouts and status of the shooter are
uncertain. Use extreme caution until
the situation is clear.Site and situation assessment The most essen-
tial determination is whether gunfire presents an
ongoing risk for the injured person, other people,
and responders.
Responder personal protection measures Latex
gloves, which the responder should put on before
approaching the injured person, are essential for
personal protection from bloodborne pathogens as
nearly always there is moderate to heavy bleeding
from gunshot injuries.
First response actionsAfter calling 911 to sum-
mon emergency aid and then determining that377