Trauma Assessment for Paramedics
From scene safety to trauma centre handover — learn the systematic approach to major trauma assessment and management in the prehospital environment.
Start Free TodayTrauma: A Systematic Approach Every Time
Major trauma is the leading cause of death in people under 40 in the UK. Paramedics play a critical role in the trauma chain — not just in treatment, but in the speed and efficiency of transport to definitive care.
The principle of prehospital trauma care is "stay and play" vs "load and go". For many major trauma patients, the most important intervention a paramedic can make is getting the patient to a Major Trauma Centre (MTC) rapidly — not spending time on scene with interventions that can be done en route or at hospital.
Time on Scene
For penetrating trauma or major haemorrhage, limit scene time to under 10 minutes where possible. Definitive haemorrhage control is surgery — prehospital intervention buys time, it doesn't replace the operating theatre.
The Primary Survey: cABCDE
c — Catastrophic Haemorrhage
Catastrophic external haemorrhage must be controlled before moving to airway. Haemorrhage control is a time-critical priority — recognising and acting on life-threatening bleeding rapidly is a core prehospital skill.
A — Airway
Is the airway open? Simple manoeuvres first (jaw thrust in trauma, avoiding neck extension). Suction if needed. Consider airway adjuncts. Surgical airway (cricothyrotomy) as last resort.
B — Breathing
Is the patient breathing? Expose the chest. Look, listen, feel. Needle decompression for tension pneumothorax. Occlusive dressing for open chest wounds. High-flow O2 in trauma (target SpO2 94–98%).
C — Circulation
Estimate blood loss. Recognise the signs of shock: tachycardia, pallor, altered consciousness, and hypotension (a late sign). Assessment of circulatory status and identification of the source of haemorrhage drives clinical decision-making.
D — Disability
AVPU or GCS. Pupil assessment. BM. Log roll with spinal precautions if indicated.
E — Exposure
Full exposure to identify all injuries. Maintain dignity and warmth — hypothermia worsens the trauma triad (hypothermia, acidosis, coagulopathy).
Major Trauma Assessment Tools
📻 METHANE
Major incident declaration: Major incident, Exact location, Type of incident, Hazards, Access, Number of casualties, Emergency services required.
🏥 Major Trauma Centres
Pre-alert MTC for: GCS ≤13, RR <10 or >29, SBP <90, penetrating trauma to torso/head, significant mechanism.
🩹 Tourniquet Use
Time-critical for arterial limb bleeding. Document time of application. Do not remove prehospital.
🌡️ Trauma Triad
Hypothermia, acidosis, and coagulopathy — the lethal triad. Preventing heat loss on scene is within every paramedic's capability.
Trauma Revision Tools
AI Patient Scenarios Pro
Work through trauma scenarios — RTC, penetrating injury, falls — and practise your primary survey, prioritisation, and pre-alert decision making.
Chat with Hollie Free
Ask Hollie to explain haemorrhagic shock physiology, the trauma triad, or walk through the cABCDE approach in detail.
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Frequently Asked Questions
What is the paramedic approach to major trauma?
Paramedics use a structured CSCATTT approach: Command, Safety, Communication, Assessment, Triage, Treatment, Transport. The primary survey (cABCDE — catastrophic haemorrhage, Airway, Breathing, Circulation, Disability, Exposure) identifies immediate life threats in order of priority. The principle is 'treat as you find' — don't move to the next step until life threats are addressed.
What is the prehospital approach to haemorrhage control?
Catastrophic external haemorrhage is addressed before airway in trauma (hence cABCDE). Rapid recognition and control of life-threatening haemorrhage is the priority — followed by systematic assessment of airway, breathing, circulation, disability, and exposure.
When do paramedics need to consider spinal immobilisation?
Current UK practice has moved away from routine spinal immobilisation. Selective immobilisation based on clinical assessment is recommended — significant mechanism, midline pain/tenderness, neurological deficit, or unreliable assessment (intoxication, distracting injury, altered consciousness). Manual in-line stabilisation and appropriate patient handling remain important in high-mechanism trauma.