Paramedics and EMRs/FRs may be called upon to care for patients with a variety of soft tissue injuries related to both minor and major trauma.  The term encompasses a broad range of conditions such as contusions, sprains, strains, tendinitis, and bursitis.  The most commonly injured soft tissues include muscles, tendons, and ligaments; complex injuries may involve multiple structures.  Common causes include falls, sports injuries, motor vehicle collisions, or assaults.

• Paramedics and EMRs/FRs should differentiate between acute and chronic injuries.  The latter are likely due to overuse or may indicate a chronic pain syndrome.  Acute pain is generally < 6 weeks duration.  Careful history taking is recommended.
• In acute injuries, maintain a high index of suspicion for an associated fracture or dislocation.
• If a fracture or dislocation is suspected, apply appropriate splinting and convey promptly.
• Assess for neurovascular impairment and convey promptly if present.
• In the case of a head, back, or neck injury, apply spinal motion restriction guidelines as indicated.

• Primary treatment consists of rest, ice, compression, and elevation.
• If open wounds are associated with the injury, irrigate with sterile saline before applying appropriate sterile dressings.
• Consider paramedic or EMR scope appropriate analgesia as indicated.

• Conduct ongoing monitoring of neurovascular function and observe for signs of compartment syndrome.
  • The anterior compartment of the lower leg is the most common site for development of compartment syndrome
  • The 6 P’s of compartment syndrome are a late sign (pain, pallor, pulselessness, paresthesia, paralysis, and poikilothermia)
• Avoid applying ice packs directly to the skin.
• If the injury involves an ankle, assess using the Ottawa Ankle Rules.
• Patients with minor injuries may meet criteria for a local waiting room pathway upon arrival at destination.

Minor Trauma