From the Guidelines
An E1 (Emergency 1) case in trauma refers to the highest priority designation for critically injured patients requiring immediate life-saving interventions, as supported by the most recent guideline on management of major bleeding and coagulopathy following trauma: sixth edition 1. These patients present with severe, time-sensitive conditions such as airway obstruction, tension pneumothorax, massive hemorrhage, or other immediately life-threatening injuries. In most trauma systems, E1 patients bypass triage and proceed directly to resuscitation areas where trauma teams are activated prior to arrival. Treatment follows the ABCDE approach (Airway, Breathing, Circulation, Disability, Exposure) with simultaneous assessment and intervention. Typical interventions include:
- Immediate airway management (often rapid sequence intubation using medications like etomidate and succinylcholine)
- Massive transfusion protocols (1:1:1 ratio of packed red blood cells, plasma, and platelets)
- Chest decompression for tension pneumothorax
- Immediate surgical intervention when indicated The E1 designation ensures these patients receive the highest resource allocation and personnel response, as delays in treatment can significantly increase mortality, as highlighted in a recent systematic review and meta-analysis of trauma care systems 1. This prioritization system is essential in trauma centers to efficiently allocate resources during multiple casualty situations and ensure that patients with the most time-critical injuries receive immediate attention, which is further emphasized by the importance of minimizing the time from injury to intervention in trauma patients with ongoing bleeding 1.
From the Research
Definition of E1 Case in Trauma
- An E1 (Emergency 1) case in trauma refers to a patient who requires immediate attention and treatment due to the severity of their injuries.
- The classification of trauma patients into different categories, such as E1, E2, and E3, is based on the severity of their injuries and the level of care they require 2.
Characteristics of E1 Case
- Patients classified as E1 are severely injured with serious neurological, respiratory, and/or hemodynamic distress 2.
- They require immediate interventions such as tracheal intubation, mechanical ventilation, chest tubing, and surgery for hemostasis 2.
- Imaging procedures for E1 patients are limited to chest x-ray, abdominal ultrasonography, and echocardiography if needed, due to the urgency of the situation 2.
Management of E1 Case
- The management of E1 patients involves a multidisciplinary team of medical professionals, including emergency physicians, anesthesiologists, surgeons, and radiologists 2, 3.
- The initial management of E1 patients aims to stabilize their vital functions, assess their injuries, and define a therapeutic strategy 4.
- The use of tranexamic acid, an antifibrinolytic agent, has been shown to reduce mortality in trauma-related hemorrhage and may be considered in the management of E1 patients 5, 6.