Prise en charge hospitalière de blessés graves

Efficient management of severely injured patients relies upon their continuous assessment. Extra-hospital evaluation allows rapid transfer and admission of the injured patient into the most adequate hospital where he (she) could receive definitive treatment of his (her) wounds. The three steps of the intra-hospital evaluation necessitate specific organisation and adaptation to current clinical guidelines. Primary assessment includes the screening for signs and causes of a potential visceral failure likely to be life-threatening; such procedure may lead to emergency care. Ultrasonographic investigations at the bedside have a major role in this evaluation. Intra-hospital transfer of an unstable patient may be required. The secondary assessment follows the complete evaluation of the patient's lesions; it allows decision making in terms of therapeutic strategy by balancing the benefits of reconstructive surgery with its related risks in some of the patients. CT scanning has a major place in the evaluation procedure. A final assessment identifies those patients likely to benefit from cardiorespiratory optimisation and specific management such as neurological care. The existence of multiple casualties due to an accidental or criminal event should modify neither the routine functioning of the organisation, nor the quality of the management defined for one patient. Such potential situation should be considered and prevented both by the administrative authority and the pre-hospital care organisation.