Multiple Traumas: Information & Specialists in Multiple Traumas

The term “polytrauma” (poly = many, numerous; trauma = injury) is derived from Greek and translates to “multiple injuries.” Polytrauma is a collective term for multiple injuries sustained simultaneously. At least one or more of these injuries, when combined, pose a life-threatening situation.

The Trauma Registry of the German Society for Trauma Surgery (DGU) reports nearly 40,000 cases of polytrauma (= life-threatening injuries) per year. Several thousand traffic fatalities are recorded annually.

The following scenarios frequently lead to polytrauma:

• Severe traffic accidents
• Workplace accidents
• Falls among the elderly or sick
• Suicide attempts
• Sports injuries

In most cases, serious traffic accidents are responsible for multiple trauma, as they involve extremely high forces—for example, when multiple vehicles collide or occupants are thrown from the vehicle. However, motorcyclists and cyclists are also disproportionately likely to be victims of serious traffic accidents and frequently suffer life-threatening or fatal injuries affecting multiple organ systems.

Work-related accidents are also among the possible causes of polytrauma, as are accidents involving older adults, such as those occurring in the home. When an older adult falls, they are more likely to suffer both broken bones and internal injuries.

Suicide attempts, in which people jump from windows or off bridges, can also lead to polytrauma. The impact not only destroys bone structures but also damages internal organs. These falls are often fatal.

Sports injuries are also among the causes of polytrauma. For example, if a hockey player is struck hard in the head by a puck, this can result in both visible damage to the head and an injury to the brain or skull bones. In this case as well, the condition is referred to as polytrauma.

Some accident victims suffer such severe polytrauma that they must be transported by helicopter © Spidi1981 | AdobeStock

There are injuries whose severity can sometimes be recognized even by a layperson, such as

• open fractures,
• deep and heavily bleeding stab and cut wounds, or
• extensive contusions.

Many serious accidents also result in amputation injuries. This means that a body part is severed. The extremities—that is, the arms and legs—are often affected. These may also be partially amputated and still connected to the trunk by a tissue bridge of varying size. In cases of severe injury, however, the affected limb is usually beyond salvage and must be surgically removed.

Often, the patient is unresponsive at this point, and significant blood loss is evident. These are all typical signs of a serious condition and may indicate life-threatening multiple trauma.

Medical personnel called to the scene will be able to diagnose polytrauma right at the accident site and respond accordingly. For example, they will monitor vital signs such as

• breathing,
• blood pressure, or
• circulatory stability

. Physical examinations can also provide initial clues at this stage.

At the hospital, imaging tests can then provide further insight into the severity of the injuries. Often,

• X-rays of the pelvic area and the cervical spine, as well as
• ultrasound examinations of the abdomen and the heart

to detect possible internal injuries. A CT scan may also be used.

Most hospitals are now able to perform a so-called “polytrauma CT” directly in the emergency room. This is particularly indicated for internal injuries, brain hemorrhages, or severe bone fractures and can visualize all injuries and sources of bleeding from head to toe within a few minutes. In cases of polytrauma, this examination can save the patient’s life.

The following protocol is generally followed in cases of polytrauma:

• Initial care at the scene of the accident (stabilizing vital signs, assessment)
• Transport to a hospital (emergency room) or a trauma center
• Performing life-saving surgeries
• Treatment or surgery for additional injuries
• Depending on the severity of the injuries: continued hospitalization
• Rehabilitation measures

What exactly is involved in providing first aid at the scene of an accident?

In the event of a serious accident, the initial focus is on emergency treatment directly at the scene of the accident. It is crucial to stabilize circulation and breathing. In the case of severe wounds, the first responder or emergency physician must also stop the bleeding to prevent excessive blood loss.

The goal of this initial treatment is to stabilize the injured person at the scene of the accident so that they can be transported to a hospital. In some cases, the patient is admitted directly to a specialized trauma center—a hospital that specializes in treating severe trauma cases. In regular hospitals, on the other hand, a so-called trauma room is available. Patients with multiple injuries are often transported by helicopter to ensure they receive appropriate treatment as quickly as possible.

What are the life-saving measures performed in the hospital?

Initial treatment takes place in the emergency room or the intensive care unit. In some cases, the patient must be taken directly to the operating room. This is necessary, for example, in cases of severe bleeding to prevent death from blood loss. 

At the hospital, a team of doctors from various specialties is assembled, such as

• trauma surgeons and
• vascular surgeons,
• neurosurgeons,
• ICU and
• emergency physicians,

to provide the best possible care for the patient.

The medical professionals then not only assess the extent of the polytrauma but can also immediately perform life-saving surgeries. These have the highest priority.

If, for example,

• extremely severe internal injuries,
• a brain hemorrhage, or
• open fractures

, these are treated immediately.

What other injuries need to be treated next?

After these life-saving surgeries, any other injuries the patient has sustained are treated. These may include ordinary bone fractures or damage to

• ligaments,
• tendons,
• muscles, or
• joints

. However, these injuries are generally not life-threatening. Therefore, these procedures are not performed until the patient is stable and out of danger.

The course of further treatment depends largely on the healing process, which can vary significantly from patient to patient. After severe multiple trauma, many patients must remain in the hospital for several weeks or even months. However, since hospitals primarily treat emergencies and serious illnesses, patients are often transferred to a “rehab clinic” following their hospital stay, if necessary.

This is necessary, among other things, when there have been severe bone fractures and the patient’s ability to walk is limited. During rehabilitation, the patient can train to regain these abilities and, under the guidance of physical therapists, return to an independent daily life. Rehabilitation treatment is also beneficial and necessary following severe brain or spinal cord injuries.

The prognosis for multiple trauma always depends on the severity of the injuries and the course of recovery. In some cases, the injuries heal without any lasting effects. Other patients, however, must live with the consequences—or even with a disability—for the rest of their lives.

Even if long-term limitations are to be expected, every effort and every bit of motivation to return to the condition one was in before the accident is worthwhile. For this reason, psychological support (e.g., in the form of behavioral therapy) is recommended for many patients after a polytrauma, especially younger working adults. The majority of patients benefit from this treatment and are able to find renewed courage to face life.