It’s a hard fact of biology. Severely damaged brain tissue doesn’t regenerate. So when it comes to traumatic brain injury (TBI), time is of the essence! It used to be thought that there was little to be done with TBI before the patient got to the hospital. Recent studies have proved this to be incorrect. In fact, EMS can do a lot for an individual before they reach the emergency room.
EPIC Treatment for TBI
To help EMS prepare for treating a patient with traumatic brain injury crews have started implementing EPIC treatment: Excellence in Prehospital Injury Care. Health care providers believe that this protocol greatly increases survival and minimizes damage to patients with head injuries. It could also potentially prevent secondary brain injuries.
Causes and Who is at Risk
The most common causes of TBI are falling, being struck, car accidents, and, intentional self-harm. These injuries most commonly occur in the elderly and the young. The CDC reports that, in 2013, falls led all other causes, accounting for 47% of all TBI-related ED visits, hospitalizations, and deaths in the United States. Falls disproportionately affect the youngest and oldest age groups:
- More than half (54%) of TBI-related ED visits hospitalizations, and deaths among children 0 to 14 years were caused by falls.
- Nearly 4 in 5 (79%) TBI-related ED visits, hospitalizations, and deaths in adults aged 65 and older were caused by falls.
The CDC also suggests measure for preventing some of these injuries. For example, ensure that children wear the right protection when they ride bikes or skateboards. They also suggest watching for tripping hazards, like throw rugs, for the elderly.
An individual suffering from a TBI can react in many different ways. Sometimes they are confused, aggressive, or unresponsive. Identifying the issue can be even harder in a patient under the influence of drugs or alcohol. It’s important not to assume that the cause of their behavior is because of the drugs or alcohol.
Take other factors into consideration as well. Inspect the patient by listening to their breathing and other organs. Gently check the patient by using palpation to check for pain they cannot identify. Be sure to keep an eye on their facial expressions. This could help identify pain they won’t or can’t verbalize.
Finally be sure to use the utmost caution when moving a patient. Use precautions as though they have spinal and neck injuries. Doing so could further prevent more damage to their bodies.
When it comes to brain injuries “time is brain,” says Bob Sullivan with EMS1.com. The longer a patient waits for treatment the greater the risk for disability or death. That’s it’s important to work together with the Emergency Room staff. This way the ER staff can prep for things like CT scans. The quicker a CT scan can be performed the better odds a patient with TBI has.
If a patient becomes unconscious you will need to act equally as quick to prevent hypoxia. This can occur due to either a blocked airway or by hyperventilation. Either way, “any single episode of hypoxia can double the mortality chance of a head-injured patient,” says Rom Duckworth.
These precautions are especially important for patients who have become unconscious. An unconscious individual can lose control over their muscle movements. This could cause a problem in two ways. The tongue may become slack and block the airway. Another possibility is that the jaw muscles could clench and prevent blood or vomit from evacuating the mouth.
Hyperventilating is equally as important to prevent. It decreases blood flow to the brain and can drastically change the chances of survival from a TBI victim.
Like with any medical emergency, assessing and acting quickly benefit the patient. That is perhaps more true with TBI than any other situation. Review relevant procedures regularly so that you’re always prepared. By implementing your training and EPIC treatment you could greatly reduce the disability and mortality rate of a patient with TBI.
PHOTO: U.S. Air Force / CC0 Public Domain