Clinical Practice Radio - Episode One - Penetrating Trauma

In this episode, the team dives into the high-acuity, low-occurrence world of penetrating trauma, a critical but often under-practiced area in pre-hospital care. They explore how limited exposure can impact clinical confidence —and discuss how cognitive overload can affect approaches during major trauma situations.

The conversation introduces the “STAB-5” approach, a UK-based system designed to guide clinicians through scene safety, triage, assertive management, bleeding control, and rapid transport, all within a targeted five-minute scene time. Emphasis is placed on early recognition of time-critical injuries, prioritising rapid transport over prolonged on-scene treatment, and using tools like direct pressure, arterial tourniquets, wound packing, and chest seals effectively.

The team also reflects on the importance of balancing interventions with the urgency to move, highlighting the role of mentation and physical appearance over vital signs in assessing perfusion. It’s a practical, engaging episode for anyone looking to sharpen their skills in managing life-threatening penetrating trauma in the field.

References 

• Winter E, Hynes AM, Shultz K, Holena DN, Malhotra NR, Cannon JW. Association of Police Transport With Survival Among Patients With Penetrating Trauma in Philadelphia, Pennsylvania. JAMA Netw Open. 2021;4(1):e2034868. doi:10.1001/jamanetworkopen.2020.34868

• Roberts I, Shakur H, Coats T, Hunt B, Balogun E, Barnetson L, Cook L, Kawahara T, Perel P, Prieto-Merino D, Ramos M, Cairns J, Guerriero C. The CRASH-2 trial: a randomised controlled trial and economic evaluation of the effects of tranexamic acid on death, vascular occlusive events and transfusion requirement in bleeding trauma patients. Health Technol Assess. 2013 Mar;17(10):1-79. doi: 10.3310/hta17100. PMID: 23477634; PMCID: PMC4780956.

• Robinson, M., Rath, F., Sutton, C. et al. STAB-5: an aide-mémoire for the efficient prehospital management of penetrating trauma by emergency medical services. Crit Care 28, 261 (2024). https://doi.org/10.1186/s13054-024-05048-1 

Figure 1 https://greatwesternairambulance.com/what-we-do/education/clinical-engagement/stab-5/