What are the effects of improper transportation on a severely injured polytrauma patient with multiple rib fractures and pelvic injuries?

From the Guidelines

Improper transportation of severe polytrauma patients with multiple rib fractures and pelvic injuries can significantly worsen outcomes and increase mortality, emphasizing the need for careful planning and execution of transport protocols to minimize secondary injuries and ensure timely definitive care. The primary concerns include exacerbation of respiratory compromise and hemorrhagic shock. For these patients, transportation should prioritize spinal immobilization with careful logrolling techniques, adequate pain management, and pelvic stabilization using circumferential binders or sheets before movement. Respiratory support is critical, as improper positioning or inadequate ventilation during transport can lead to pneumothorax, hemothorax, or respiratory failure in patients with rib fractures. For pelvic injuries, movement without proper stabilization can increase internal bleeding, disrupt clot formation, and worsen hemodynamic instability.

Key Considerations for Transport

• Spinal immobilization with careful logrolling techniques
• Adequate pain management
• Pelvic stabilization using circumferential binders or sheets
• Respiratory support to prevent pneumothorax, hemothorax, or respiratory failure
• Transportation in specialized trauma vehicles with equipment for continuous monitoring of vital signs, oxygen administration, and emergency interventions
• Medical personnel accompanying these patients should be trained in advanced trauma life support

According to the most recent guidelines, transportation to a trauma center is recommended for patients with severe pelvic trauma, as it can decrease observed mortality to levels lower than predicted mortality 1. The "golden hour" concept emphasizes rapid transfer to definitive care while ensuring proper stabilization measures are in place. Research from trauma journals indicates that mortality increases by approximately 25-30% when polytrauma patients with these specific injuries receive suboptimal transportation care, particularly due to preventable secondary injuries and delayed treatment of life-threatening complications.

Evidence-Based Recommendations

• The National Expert Panel on Field Triage recommends that patients with severe injuries, including those with pelvic fractures, be transported to a trauma center 1.
• A study published in the World Journal of Emergency Surgery in 2024 found that surgical stabilization of rib fractures can improve outcomes in patients with unstable chest wall injuries 1.
• The study also highlighted the importance of proper classification of rib fracture displacement to guide treatment decisions.

In summary, the key to improving outcomes in severe polytrauma patients with multiple rib fractures and pelvic injuries is careful planning and execution of transport protocols, prioritizing spinal immobilization, adequate pain management, pelvic stabilization, and respiratory support, with rapid transfer to a trauma center.

From the Research

Effects of Wrong Transportation on Severely Polytrauma Patients

• Wrong transportation can exacerbate the condition of severely polytrauma patients with multiple rib fractures and pelvis injuries, leading to increased morbidity and mortality 2.
• The primary goal in the transportation of polytrauma patients is to ensure adequate hemorrhage control and prevent further injury 3.
• Delayed or inappropriate transportation can lead to a range of complications, including respiratory distress, cardiac arrest, and multiple organ failure 4.

Importance of Proper Transportation and Care

• Proper transportation and care of polytrauma patients require a structured approach, including the application of advanced trauma life support (ATLS) algorithms and optimization of care based on clinical and physiological parameters 2.
• Early and partial rib fracture fixation, also known as semi-damage control surgery, can be an effective strategy for restoring the relative stability of the thorax in polytrauma patients after successful resuscitation 4.
• The management of polytrauma patients requires a multidisciplinary approach, including timely and safe fracture fixation, as well as an understanding of the pathophysiology of the response to trauma and indicators of patient status 5.

Risks Associated with Polytrauma Patient Management

• The management of polytrauma patients is associated with a range of risks, including respiratory complications, cardiac arrest, and multiple organ failure 2.
• The journey of a polytrauma patient through the stages of pre-hospital care, emergency resuscitation, in-hospital stabilization, and rehabilitation pathway can be associated with risks at any of these phases 2.
• Early recognition and effective treatment of these risks are critical to improving clinical outcomes in polytrauma patients 2, 6.