Traumatic Arrest Scenario (ECA)

What is your first priority on arrival at scene?

You deem the scene safe as Police have closed the nearest lane and all roadworks have ceased. Bystanders report that a heavy piece of machinery fell and crushed the patient across his mid-drift, and they were able to remove it after 2–3 minutes. You confirm cardiac arrest and there is only you and your Paramedic colleague to begin ALS. What is your next priority?

What does HOTT stand for?

You begin the HOTT approach. You have applied a pelvic binder and assisted with bilateral thoracic decompression, while your colleague inserts an I-gel to address hypoxia. More Police arrive and ask if they can assist. While you are completing HOTT principles, can Police assist by starting compressions?

You swap with your Paramedic colleague so you can ventilate the patient while they gain IV/IO access. Once access is gained, what medications may the Paramedic give during a traumatic cardiac arrest?

The initial rhythm on the first pulse check was PEA, so CPR continues. Access is gained and fluid, TXA, and adrenaline are administered.  The second crew arrives and assists with ALS. No external haemorrhage has been identified, and you believe HOTT principles have now been completed within your current scope of practice. What else could you consider (if sufficient personnel are present) that can be incorporated into the HOTT approach?

Should you still consider elements of reversible causes within the 4 H’s and 4 T’s in a traumatic cardiac arrest?

Helimed arrives and takes over clinical decision-making, including advanced management and treatments. What additional skills or treatments can they bring to support traumatic cardiac arrest care?

If ROSC is achieved in traumatic cardiac arrest, what should be the destination hospital?

Does management of traumatic cardiac arrest differ depending on whether the trauma is penetrating or blunt?

Why are shocks less common in traumatic cardiac arrest?

In traumatic cardiac arrest, pelvic binders are primarily used to…

What is the main reason spinal immobilisation may be deprioritised in traumatic cardiac arrest?

Which statement about adrenaline in traumatic cardiac arrest is most accurate? 

When managing traumatic cardiac arrest, which statement is true?