International trauma life support for emergency care providers.

432 Pages·2015·70.094 MB·English

GLOBAL
EDITION
International Trauma Life Support
for Emergency Care Providers
EIGHTH EDITION
John E. Campbell,
MD, FACEP
Roy L. Alson, PhD, MD, FACEP, FAAEM
and Alabama Chapter, American College of Emergency Physicians
I N T E R N AT I O N A L
Trauma Life Support
for Emergency Care Providers
Eighth Edit ion
Global Edition
John E. Campbell,
MD, FACEP
Roy L. Alson,
PhD, MD, FACEP, FAAEM
and Alabama Chapter,
American College of Emergency Physicians
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Publisher: Julie Levin Alexander Notice on Care Procedures
Publisher’s Assistant: Sarah Henrich It is the intent of the authors and publisher that this textbook be used as part
Acquisitions Editor: Sladjana Repic Bruno of an education program taught by qualified instructors and supervised by a
Program Manager: Monica Moosang licensed physician, in compliance with rules and regulations of the
Development Editor: Jo Cepeda jurisdiction where the course is being offered. The procedures described in
Editorial Assistant: Lisa Narine this textbook are based upon consultation with emergency care providers
Project Management Lead: Cynthia Zonneveld including EMTs, paramedics, nurses, and physicians, who are actively
Project Manager: Julie Boddorf involved in prehospital care. As a field, prehospital medicine is constantly
Full-Service Project Manager: Peggy Kellar, iEnergizer Aptara®, Ltd. evolving. The authors and publisher have taken care to make certain that
Director of Marketing: David Gesell these procedures reflect currently accepted clinical practice; however, the
Marketing Manager: Brian Hoehl procedures cannot be considered absolute recommendations, nor do they
Project Manager, Global Edition: Ruchi Sachdev supersede applicable local laws or rules and the medical supervision of the
Associate Acquisitions Editor, Global Edition: Ananya Srivastava prehospital provider.
Project Editor, Global Edition: Rahul Arora The material in this textbook contains the most current information available
Senior Manufacturing Controller, Production, Global Edition: at the time of publication. However, international, national, federal, state,
Trudy Kimber provincial, and local guidelines concerning clinical practices, including,
Marketing Specialist: Michael Sirinides without limitation, those governing infection control and universal
Marketing Assistant: Amy Pfund precautions, change rapidly. The reader should note, therefore, that new
Manufacturing Buyer: Mary Ann Gloriande regulations may require changes in some procedures.
Interior and Cover Art Director: Diane Ernsberger
Interior Designer: Studio Montage The references to products in this text do not represent an official
Cover Designer: Lumina Datamatics, Inc. endorsement by ITLS. Efforts have been made to include multiple types of
Cover Photo: Micolas, Shutterstock devices, for illustrative purposes, when possible. It is impossible to include in
Composition: iEnergizer Aptara®, Ltd. this text an example of every type of device. As in other areas of medicine,
Printing and Binding: Vivar, Malaysia there is ongoing development of equipment for use in the care of the
Cover Printer: Vivar, Malaysia prehospital trauma patient, which the authors and editors believe is good. It
remains the responsibility of the ITLS provider in conjunction with local
Credits and acknowledgments for content borrowed from other sources medical direction to determine which specific devices are applicable in their
and reproduced, with permission, in this textbook appear on the specific practice setting.
appropriate page within text. It is the responsibility of the reader to familiarize himself or herself with the
policies and procedures set by federal, state, provincial, and local agencies
Pearson Education Limited as well as the institution or agency where the reader is employed. The
Edinburgh Gate authors and the publisher of this textbook and the supplements written to
Harlow accompany it disclaim any liability, loss, or risk resulting directly or
Essex CM20 2JE indirectly from the suggested procedures and theory, from any undetected
England errors, or from the reader’s misunderstanding of the text. It is the reader’s
and Associated Companies throughout the world responsibility to stay informed of any new changes or recommendations
made by any national, federal, state, provincial, and local agency as well as
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Notice on Gender Usage
© Pearson Education Limited 2018 The English language has historically given preference to the male gender.
Authorized adaptation from the United States edition, entitled International Trauma Among many words, the pronouns, he and his are commonly used to
Life Support for Emergency Care Providers, 8th edition, ISBN 978-0-13-413079-8, describe both genders. Society evolves faster than language, and the male
published by Pearson Education © 2016. pronouns still predominate our speech. The authors have made great effort
to treat the two genders equally, recognizing that a significant percentage of
All rights reserved. No part of this publication may be reproduced, stored in a EMS providers are female. However, in some instances, male pronouns may
retrieval system, or transmitted in any form or by any means, electronic, be used to describe both males and females solely for the purpose of brevity.
mechanical, photocopying, recording or otherwise, without either the prior This is not intended to offend any readers of the female gender.
written permission of the publisher or a license permitting restricted copying in
the United Kingdom issued by the Copyright Licensing Agency Ltd, Saffron Notice on Prehospital Personnel Designation
House, 6–10 Kirby Street, London EC1N 8TS. Around the world, the credentialing and training of personnel who provide
prehospital care vary greatly. In some jurisdictions, physicians and nurses
All trademarks used herein are the property of their respective owners. respond as part of the EMS crew, whereas in other areas, those responding
The use of any trademark in this text does not vest in the author or may only be trained to a basic life support (BLS) level. As the principles of
publisher any trademark ownership rights in such trademarks, nor does care of the multiple trauma patient are the same regardless of the level of
the use of such trademarks imply any affiliation with or endorsement of training of the persons providing care, the authors and publisher have
this book by such owners. attempted to describe those care providers in generic terms throughout the
For information regarding permissions, request forms and the appropriate book. Common terms in English such as medic or emergency medical responder
contacts within the Pearson Education Global Rights & Permissions are, in some jurisdictions, actual certification levels of personnel. The term
department, please visit www.pearsoned.com/permissions/. emergency care provider is used in this text to describe all levels of personnel
who provide care in the prehospital setting. When other common terms are
ISBN 10: 1-292-17084-0 used to refer to persons providing care, it is intended to represent all persons
ISBN 13: 978-1292-17084-8 who provide prehospital care and not to exclude or offend any care provider.
British Library Cataloguing-in-Publication Data
A catalogue record for this book is available from the British Library.
10 9 8 7 6 5 4 3 2 1
14 13 12 11 10
Dedication
The best way to find yourself is to lose yourself in the service of others.
– Mohandas K. Gandhi
This eighth edition of the ITLS textbook is dedicated to the men and women who each day
answer the call for help. Every hour of every day they stand watch keeping our fellow
citizens, our friends, and our families safe. When crises arise, they are there, providing care
and comfort, often at great risk to themselves. And each year, all over the world, some of
our colleagues make the ultimate sacrifice. We honor them and their families in our resolve
to continue to “answer the call.” We can think of no one who better epitomizes that
dedication better than our friend and colleague Vickey G. Lewis, RN, BSN.
Vickey has been a first responder, ED RN, EMS and Nurse educator, and a fixture in ITLS
for 30 years. She was certified in the first BTLS course taught in North Carolina in the early
1980s, served as the first chapter coordinator for North Carolina BTLS (now ITLS),
establishing a training program that continues to grow. Furthermore,
she has shared her knowledge and experience with others, all across
the globe as they sought to bring the program to their communities.
She taught hundreds of providers how to care for trauma patients as
well as established educational programs for providers and citizens to
deal with cardiac arrest. She has served as the speaker of the ITLS
annual delegate meeting for over 10 years, “herding the cats” with
both knowledge and humor. Over her long career, she consistently
gives credit to others for what is accomplished. As an organization and
as individual providers and educators, we have greatly benefited from
her wisdom, experience, and dedication. For that we are truly grateful.
Vickey G. Lewis, RN, BSN
Table of Contents
Chapter 1 Scene Size-up 17 Chapter 12 Spine Management Skills 251
Chapter 2 Trauma Assessment and Management 44 Chapter 13 Abdominal Trauma 271
Chapter 3 Assessment Skills 66 Chapter 14 Extremity Trauma 281
Chapter 4 Airway Management 81 Chapter 15 Extremity Trauma Skills 305
Chapter 5 Airway Skills 103 Chapter 16 Burns 319
Chapter 6 Thoracic Trauma 140 Chapter 17 Pediatric Trauma 341
Chapter 7 Thoracic Trauma Skills 161 Chapter 18 Geriatric Trauma 364
Chapter 8 Shock 169 Chapter 19 Trauma in Pregnancy 375
Chapter 9 Vascular Access Skills 193 Chapter 20 The Impaired Patient 386
Chapter 10 Head Trauma and Traumatic Brain Chapter 21 Trauma Arrest 395
Injury 205
Chapter 22 Standard Precautions and Transmission-
Chapter 11 Spinal Trauma and Patient-Centered Spinal Based Precautions 407
Motion Restriction 224
Index 425
4
About the Editors
John E. Campbell,
MD, FACEP
Dr. Campbell received his BS ITLS. Dr. Campbell has served as its president since the
degree in pharmacy from inception of the organization.
Auburn University in 1966 Dr. Campbell is the author of the first edition of the
and his medical degree from Basic Trauma Life Support textbook and has continued to
the University of Alabama at be the editor through to this new edition, now entitled
Birmingham in 1970. He has International Trauma Life Support for Emergency Care Pro-
been in the practice of Emer- viders. He also is the coauthor of Homeland Security and
gency Medicine for 40 years, Emergency Medical Response and Tactical Emergency Medi-
practicing in Alabama, Georgia, New Mexico, and Texas. cal Essentials.
He became interested in prehospital care in 1972 when he
He was a member of the first faculty of Emergency
was asked to teach a basic EMT course to members of the
Medicine at the School of Medicine, University of Ala-
Clay County Rescue Squad. He is still an honorary mem-
bama at Birmingham. In 1991 he was the first recipient
ber of that outstanding group. Since then, he has served as
of the American College of Emergency Medicine’s EMS
medical director of many EMT and paramedic training
Award for outstanding achievement of national signifi-
programs. He recently retired as the Medical Director for
cance in the area of EMS. In 2001 he received the Ronald
EMS and Trauma for the State of Alabama.
D. Stewart Lifetime Achievement Award from the
From the original basic trauma life support course devel- National Association of EMS Physicians. He is currently
oped an international organization of teachers of trauma retired from clinical practice and resides in Montgom-
care called “International Trauma Life Support, Inc.,” or ery, Alabama.
Roy L. Alson, PhD,
MD, FACEP, FAAEM
Dr. Roy L. Alson is an Associ- member of the Winston-Salem Rescue Squad and began
ate Professor of Emergency working for the Forsyth County EMS as an EMT. Upon
Medicine at the Wake Forest completion of his residency, Dr. Alson returned to Wake
University School of Medicine Forest University and the Forsyth County EMS system,
and Director of the Office of serving as Assistant Medical Director for 14 years and
Prehospital and Disaster Medical Director for the last 12 years. He remains actively
Medicine at Wake Forest. He involved in the education of EMS personnel.
is also an Associate Professor Dr. Alson’s involvement with ITLS dates to the 1980s. He
at the Childress Institute for served as the North Carolina Chapter Medical Director for
Pediatric Trauma at Wake 15 years. Since the 1990s he has been a member of the edi-
Forest University. He received his bachelor’s degree from torial board for ITLS as well as a contributing author. With
the University of Virginia in 1974 and both his PhD and MD this edition, he joins Dr. Campbell as co-editor in chief.
from the Bowman Gray School of Medicine of Wake Forest
Along with EMS, disaster medicine is an area of inter-
University (1982, 1985). He completed his residency in emer-
est. Dr. Alson serves as the Medical Director for the
gency medicine at Allegheny General Hospital in Pittsburgh,
North Carolina State Medical Response System (NC
Pennsylvania, and is board certified in both emergency
SMAT) program. He has served as the Chairman of the
medicine and emergency medical services by the American
Disaster Preparedness and Response Committee for
Board of Emergency Medicine.
American College of Emergency Physicians, as well as
His EMS career began in the early 1970s as an EMT in New a member of the EMS Committee for the American
York City. As a graduate student, Dr. Alson became a Academy of Emergency Physicians. He is the Chairman
5
6 AbouT ThE AuThoRS
for the NAEMSP Disaster Preparedness Committee for Dr. Alson has responded to numerous nationally declared
2014-16. disasters. He continues to teach about the delivery of care
He has served with the National Disaster Medical System in austere and surge-type conditions and has lectured
(NDMS) for 20 years and is currently a member of the nationally and internationally on prehospital trauma care
International Medical Surgical Response Team East and disaster medicine.
(IMSURT–E). He previously served as the Commander He and his wife, Rebecca, reside in Winston-Salem.
and Deputy Commander for the North Carolina Disaster
Medical Assistance Team (NC-DMAT-1).
About the Authors
ITLS for Emergency Sabina A. braithwaite, MD, MPh, FACEP,
Care Providers, 8th Edition, NREMTP
Clinical Associate Professor of Emergency Medicine,
Global Edition
University of Kansas Medical Center, Kansas City; Clinical
Associate Professor of Preventive Medicine and Public
Roy L. Alson, PhD, MD, FACEP, FAAEM
Health, University of Kansas Medical Center, Wichita;
Associate Professor of Emergency Medicine and Director,
Associate Medical Director, Medical Control Board, EMS
Office of Prehospital and Disaster Medicine, Wake Forest
System for Metropolitan Oklahoma City and Tulsa; Vice
University School of Medicine, Winston-Salem, NC;
Chair, Board of Directors, International Trauma Life Support
Medical Director, Forsyth County EMS, Winston-Salem,
NC; Medical Advisor, Disaster Services, NC Office of EMS, Jeremy J. brywczynski, MD
Raleigh, NC Assistant Professor, Emergency Medicine, Vanderbilt
University Medical Center, Nashville, TN; Medical
James J. Augustine, MD
Director, Vanderbilt LifeFlight; Medical Director,
Director of Clinical Operations, EMP Ltd, Canton, OH;
Vanderbilt FlightComm; Assistant Medical Director,
Assistant Clinical Professor, Department of Emergency
Nashville (TN) Fire Department
Medicine, Wright State University, Dayton, OH; Chair,
ASTM Task Group E54.02.01, Standards for Hospital John E. Campbell, MD, FACEP
Preparedness Under Committee E54 on Homeland Medical Director, EMS and Trauma, State of Alabama,
Security Applications; former Medical Director, Atlanta Retired
Fire Rescue Department and the District of Columbia Fire
Alexandra Charpentier, EMT-P
and EMS Department.
EMS Director, Heart of Texas Healthcare System EMS,
Jere baldwin, MD, FACEP, FAAFP Brady, TX
Chief, Department of Emergency Medicine and
Leon Charpentier, EMT-P
Ambulatory Services, Mercy Hospital, Port Huron, MI
Harker Heights (TX) Fire Chief, Retired
Graciela M. bauza, MD
James h. Creel, Jr. MD, FACEP
Assistant Professor of Surgery, University of Pittsburgh,
Clinical Associate Professor and Program Director,
Pittsburgh, PA
Department of Emergency Medicine, University of Tennessee
Russell bieniek, MD, FACEP College of Medicine (UTCOM); Chief of Emergency
Director of Emergency Preparedness, UPMC Hamot, Medicine, Erlanger Health System, Chattanooga, TN
Erie, PA
Ann M. Dietrich, MD, FAAP, FACEP
William bozeman, MD, FACEP, FAAEM Professor of Pediatrics, Ohio State University; Director of
Professor, Department of Emergency Medicine, and Risk Management, Section of Emergency Medicine,
Associate Research Director, Wake Forest University School Columbus (OH) Children’s Hospital; Pediatric Medical
of Medicine, Winston-Salem, NC; Lead Physician, Tactical Advisor, Medflight of Ohio
Operations, Forsyth County EMS, Winston-Salem, NC
Ray Fowler, MD, FACEP, DbAEMS
Walter J. bradley, MD, MbA, FACEP Professor and Chief, Division of Emergency Medical
Medical Director, Illinois State Police; SWAT Team Services, The University of Texas, Southwestern Medical
Physician, Moline Police Department; Physician Advisor, Center; Attending Emergency Medicine Faculty, Parkland
Trinity Medical Center, Moline, IL Memorial Hospital, Dallas, TX
AbouT ThE AuThoRS 7
Pam Gersch, RN, CLNC Richard N. Nelson, MD, FACEP
Program Director, AirMed Team, Rocky Mountain Professor and Vice Chair, Department of Emergency
Helicopters, Redding, CA Medicine, The Ohio State University College of
Medicine
Martin Greenberg, MD, FAAoS, FACS
Chief of Hand Surgery, Advocate Illinois Masonic Medical Jonathan Newman, MD, MMM, FACEP
Center; Chief of Orthopedic Surgery, Our Lady of the Assistant Medical Director, United Hospital Center,
Resurrection Medical Center, Chicago, IL; Reserve Police Bridgeport, WV
Officer, Village of Tinley Park, IL; Tactical Physician,
bob Page, MEd, NRP, CCP, NCEE
South Suburban Emergency Response Team; ITOA
Co-Chair, TEMS Committee Edutainment Consulting and Seminars, LLC
Kyee h. han, MbbS, FRCS, FCEM Wm. bruce Patterson, Platoon Chief/EMT-P
Consultant in Accident and Emergency Medicine; Medical Strathcona County Emergency Services
Director, North East Ambulance Service NHS Trust;
Andrew b. Peitzman, MD
Honorary Clinical Senior Lecturer, The James Cook
University Hospital, Middlesbrough, UK Mark M. Ravitch
Donna hastings, MA, EMT-P, CPCC Professor and Executive Vice-Chairman, Department of
Surgery, and Chief, Division of General Surgery,
Chair, ITLS Editorial Board; CEO, Heart and Stroke
University of Pittsburgh
Foundation of Alberta, NWT and Nunavut, Calgary, Canada
Leah J. heimbach, JD, RN, EMT-P Paul E. Pepe, MD, MPh
Principal, Healthcare Management Solutions, LLC, White Professor of Emergency Medicine, Internal Medicine,
Hall, WV Pediatrics, Public Health and Riggs Family Chair in
Emergency Medicine, University of Texas Southwestern
Eduardo Romero hicks, MD, EMT Medical Center and Parkland Emergency-Trauma Center;
Director, Sistema de Urgencias del Estado de Guanajuato, Director, City of Dallas Medical Emergency Services for
Guanajuato State Emergency System, México; Associate Public Safety, Public Health and Homeland Security,
Professor, University of Guanajuato Nursing School, Dallas, TX
Guanajuato, México; Medical Director, ITLS Guanajuato
México Chapter William F. Pfeifer, MD, FACS
Professor of Surgery, Department of Specialty Medicine,
Ahamed h. Idris, MD
Rocky Vista University College of Osteopathic Medicine;
Professor of Surgery and Medicine and Director, DFW Mile High Surgical Specialists, Littleton, CO; Colonel MC
Center for Resuscitation Research, UT Southwestern USAR (ret)
Medical Center at Dallas, TX
Art Proust, MD, FACEP
David Maatman, NRP/IC
Associate Medical Director, SFVEMSS, Geneva, IL
Kirk Magee MD, MSc, FRCPC
Mario Luis Ramirez, MD, MPP
Associate Professor, Dalhousie Department of Emergency
Tactical and Prehospital EMS Fellow and Clinical
Medicine, Halifax, Nova Scotia
Instructor in Emergency Medicine, Department of
Patrick J. Maloney, MD Emergency Medicine, Vanderbilt University Medical
Staff Physician, Denver (CO) Health Medical Center and Center, Nashville, TN
Denver Emergency, Center for Children; Clinical
Jonathan M. Rubin, MD, FAAEM
Instructor, University of Colorado School of Medicine,
Associate Professor of Emergency Medicine, Medical
Denver, CO
College of Wisconsin
David Manthey, MD, FACEP, FAAEM
S. Robert Seitz, MEd, RN, NRP
Professor of Emergency Medicine and Vice Chair of
Assistant Professor, School of Health and Rehabilitation
Education, Wake Forest University School of Medicine,
Sciences, Emergency Medicine Program, University of
Winston-Salem, NC
Pittsburgh; Assistant Program Director, Office of
Leslie K. Mihalov, MD Education and International Emergency Medicine,
Chief, Emergency Medicine, and Medical Director, University of Pittsburgh Center for Emergency Medicine;
Emergency Services, Nationwide Children’s Hospital; Continuing Education Editor, Journal of Emergency
Associate Professor of Pediatrics at The Ohio State Medical Services; Editorial Board, International Trauma
University College of Medicine Life Support
8 AbouT ThE AuThoRS
Corey M. Slovis, MD, FACP, FACEP, FAAEM Katherine West, bSN, MSEd, CIC
Professor of Emergency Medicine and Medicine and Infection Control Consultant, Manassas, VA; Member
Chairman, Department of Emergency Medicine, JEMS Editorial Board
Vanderbilt University Medical Center, Nashville, TN;
Melissa White, MD, MPh
Medical Director, Metro Nashville Fire Department and
Assistant Professor, Assistant Residency Director, and
International Airport
Medical Director, John’s Creek Fire Department; Medical
J. T. Stevens, NRP (ret.) Director, Emory Emergency Medical Services; Associate
Sun City, SC Medical Director, Emory Flight/Air Methods, GA;
Department of Emergency Medicine, Emory University
Ronald D. Stewart, oC, oNS, ECNS, bA, bSc,
School of Medicine, Atlanta, GA
MD, FACEP, DSc, LLD
Janet M. Williams, MD
Professor Emeritus, Medical Education, and Professor of
Emergency Medicine and Anaesthesia, Dalhousie Professor of Emergency Medicine, University of Rochester
University, Halifax, Nova Scotia, Canada (NY) Medical Center
E. John Wipfler, III, MD, FACEP
Shin Tsuruoka, MD
Attending Emergency Physician, OSF Saint Francis
Vice director and Chief of Neurosurgical Department, JA
Medical Center Residency Program; Medical Director,
Toride Medical Center, Toride, Japan; ITLS Japan Chapter
STATT TacMed Unit, Tactical Medicine; Sheriff’s
Medical Director
Physician, Peoria County (IL) Sheriff’s Office; Clinical
Arlo Weltge, MD, MPh, FACEP Associate Professor of Surgery, University of Illinois
Clinical Associate Professor of Emergency Medicine, College of Medicine, Peoria, IL
University of Texas, Houston Medical School; Medical
Arthur h. Yancey II, MD, MPh, FACEP
Director, Program in EMS, Houston Community College
Deputy Director of Health for EMS, Fulton County
howard A. Werman, MD, FACEP Department of Health and Wellness, Atlanta, GA;
Professor of Clinical Emergency Medicine, The Ohio State Associate Professor, Department of Emergency Medicine,
University; Medical Director, MedFlight of Ohio Emory University School of Medicine, Atlanta, GA
What’s New in This Edition
The eighth edition of the ITLS textbook, International Trauma problems but must delegate the needed actions to team
Life Support for Emergency Care Providers, has been updated members. That emphasizes the team concept and keeps
to provide the emergency care provider with information on scene time at a minimum. The order of presentation
on the latest and most effective approaches to the care of the of the three assessments (ITLS P rimary Survey, ITLS
trauma patient. The science of trauma is constantly evolv- Ongoing Exam, and ITLS Secondary Survey) has been
ing, and the research working group at ITLS has worked to changed. The ITLS Ongoing Exam is performed before
bring to the authors and the text information that is perti- the ITLS Secondary S urvey, a more common situation,
nent to the initial care of the trauma patient. and may replace it. The use of finger-stick serum lactate
One of the biggest changes in this edition is that Dr. Roy levels and prehospital abdominal ultrasound exams are
Alson has joined Dr. John Campbell as co-editor in chief. mentioned as areas of current study to better identify
Dr. Alson is a board-certified EM and EMS physician with patients who may be in early shock.
extensive experience in EMS care and education and has • Chapter 3 reflects the changes in Chapter 2.
been a contributor to the ITLS text and course for over • In Chapter 4, capnography is stressed as the standard
25 years. for confirming and monitoring the position of the
The text again conforms to the latest AHA/ILCOR guide- endotracheal tube as well as the best way to assess for
lines for artificial ventilation and CPR. The case presenta- hyperventilation or hypoventilation. The volume of air
tions used in many of the chapters draw upon a single delivered with each ventilation now emphasizes the
scenario as an effort to have the illustrative cases used response of the patient (rise and fall of the chest) rather
reflect a more realistic situation. Although trauma can than a fixed volume amount.
result in single-system injuries, major trauma victims • In Chapter 5, fiberoptic and video intubation are dis-
often have multiple organ systems or body areas involved, cussed as evolving technologies. Drug-assisted intuba-
and these must all be assessed and stabilized. tion is now included in this chapter, rather than in the
The text continues the presentation of Key Terms and appendix, because it is more commonly used. The key
updates of photos and drawings as needed. There is now role of blind insertion airway devices (BIADs) in basic
also a new student and instructor resource Web site, which airway management is reinforced.
provides additional information beyond the core material • In Chapter 6, a discussion of the indications for decom-
of ITLS. pressing pericardial tamponade has been added, when
such a procedure is in the emergency care provider’s
Some of the chapter-by-chapter changes and key compo-
scope of practice. Also discussed is the use of ultrasound
nents are listed here:
to identify such injuries and also to identify a pneumo-
• In the Introduction it is explained what the concept of thorax.
the “Golden Period” is and why it remains important to • In Chapter 7, there is a revised discussion of needle
what we do. decompression of the chest for a tension pneumothorax
• In Chapter 1, the emphasis on scene safety continues to be reflecting challenges faced by tactical EMS providers.
a central component, as is the concept that trauma care is • In Chapter 8, the discussion of hemorrhagic shock has
a team effort involving many disciplines. There is a dis- again been updated to reflect the latest experience of
cussion of the changes in response put forth by the Hart- the military during the recent conflicts. A discussion of
ford Consensus. the role of tranexamic acid (TXA) in the management
• In Chapter 2, minor changes have been made in the of hemorrhage has been added.
assessment sequence based on feedback from ITLS • Chapters 11 and 12 now reflect current science and pub-
instructors and providers. The importance of identifying lished guidelines. There has been a complete revision of
and controlling at the start of the assessment is rein- when to apply spinal motion restriction. In addition, the
forced. As the leader performs the assessment, he or she transport of a patient on a backboard is now discour-
will delegate responses to abnormalities found in the ini- aged. Included also is how to remove the patient from
tial assessment. This is to reinforce the rule that the the backboard once placed on a transport stretcher. The
leader must not interrupt the assessment to deal with standing backboard procedure has been eliminated.
9