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When someone is seriously injured in a car crash, fall or other traumatic event, the first few minutes are critical.
While getting the patient to hospital quickly is important, what paramedics do before they arrive at hospital can have a major impact on whether that person survives.
One of the biggest challenges in trauma care is preventing what healthcare professionals call the trauma triad or lethal triad. “This is a dangerous chain reaction that can develop after severe injuries and heavy blood loss,” says Kirsten Roelfse, an Emergency Care Practitioner at ER24 East Metro. “It consists of three closely linked problems: hypothermia (a dangerously low body temperature), acidosis (a build-up of acid in the body) and coagulopathy (when the blood can no longer clot properly).
Each of these conditions makes the others worse. Unless the cycle is interrupted quickly, it can become increasingly difficult for the body to recover.
Hypothermia: More than just feeling cold
Many people think hypothermia only happens in freezing temperatures, but trauma patients can become dangerously cold even on a warm day.
“After a serious injury, the body loses heat more quickly because of blood loss, shock, wet clothing and exposure to the environment,” Roelfse explains. “Lying on cold ground can cause body temperature to drop.”
This is a serious concern because the body’s natural clotting process works best at a normal temperature. As body temperature falls, it becomes harder for blood to clot, making it more difficult to stop bleeding.
“To prevent this, we work hard to keep patients warm,” Roelfse says. “We will cover them with thermal blankets, protect them from wind and rain, remove wet clothing where possible and minimise unnecessary exposure while treating injuries.”
Acidosis: When the body runs out of oxygen
Blood carries oxygen to every organ and tissue in the body. After severe blood loss, there may not be enough oxygen reaching these vital organs.
When this happens, the body’s cells switch to a less efficient way of producing energy, leading to a build-up of acid in the bloodstream. This condition is known as acidosis.
“As acid levels rise, the heart and other organs do not function as effectively,” says Roelfse. “Acidosis also makes it harder for the body to form stable blood clots, allowing bleeding to continue.”
Paramedics help reduce the risk of acidosis by controlling severe bleeding as quickly as possible, supporting breathing and oxygen levels, and maintaining blood flow to the body’s vital organs until the patient reaches the hospital.
Coagulopathy: When the blood can’t clot
Normally, when someone is injured, the body quickly forms blood clots to stop bleeding. “However, after major trauma, this process can begin to fail,” says Roelfse. Blood loss, hypothermia and acidosis all interfere with the body’s ability to clot, a condition known as coagulopathy.
“Without effective clotting, even small blood vessels may continue to bleed, causing further blood loss and making the patient’s condition increasingly unstable,” she adds.
This is why paramedics focus on controlling bleeding from the very beginning. They use techniques such as direct pressure and specialised dressings and in some cases tourniquets to reduce blood loss before the patient reaches the hospital.
Breaking the cycle
The trauma triad is dangerous because each problem feeds the next. Bleeding causes the body to lose heat and oxygen. Falling body temperature and rising acid levels make it harder for the blood to clot. Poor clotting leads to more bleeding, and the cycle continues.
“By stopping severe bleeding, keeping patients warm, providing oxygen and carefully supporting circulation, ER24 paramedics help prevent the trauma triad from taking hold,” says Roelfse. “These early interventions buy valuable time and give hospital teams the best possible chance of saving the patient’s life.”