Polytrauma or multiple trauma is a medical term describing the condition of a person who has been subjected to multiple traumatic injuries

Physical trauma

Trauma refers to "a body wound or shock produced by sudden physical injury, as from violence or accident." It can also be described as "a physical wound or injury, such as a fracture or blow." Major trauma can result in secondary complications such as circulatory shock, respiratory failure and death...

, such as a serious head injury in addition to a serious burn. It is defined via an Injury Severity Score

Injury Severity Score

The Injury Severity Score is an established medical score to assess trauma severity. It correlates with mortality, morbidity and hospitalization time after trauma...

 ISS >=17. The term has become common among US military doctors in describing the seriously injured soldiers returning from Operation Iraqi Freedom (Iraq

Iraq

Iraq ; officially the Republic of Iraq is a country in Western Asia spanning most of the northwestern end of the Zagros mountain range, the eastern part of the Syrian Desert and the northern part of the Arabian Desert....

) and Operation Enduring Freedom (Afghanistan

Afghanistan

Afghanistan , officially the Islamic Republic of Afghanistan, is a landlocked country located in the centre of Asia, forming South Asia, Central Asia and the Middle East. With a population of about 29 million, it has an area of , making it the 42nd most populous and 41st largest nation in the world...

). The term however is generic, and has been in use for a long time for any case involving multiple traumata.

Civilian medicine

In civilian life, polytraumas are often associated with motor vehicle accidents

Car accident

A traffic collision, also known as a traffic accident, motor vehicle collision, motor vehicle accident, car accident, automobile accident, Road Traffic Collision or car crash, occurs when a vehicle collides with another vehicle, pedestrian, animal, road debris, or other stationary obstruction,...

. This is because car accidents often occur at a high velocities causing multiple injuries. On admission to hospital any trauma patient should immediately undergo x-ray

Medical imaging

Medical imaging is the technique and process used to create images of the human body for clinical purposes or medical science...

 diagnosis of their cervical spine, chest

Chest X-ray

In medicine, a chest radiograph, commonly called a chest X-ray , is a projection radiograph of the chest used to diagnose conditions affecting the chest, its contents, and nearby structures...

 and their pelvis

Pelvis

In human anatomy, the pelvis is the lower part of the trunk, between the abdomen and the lower limbs .The pelvis includes several structures:...

, commonly known as a 'trauma series', to ascertain possible life threatening injuries. Examples would be a fractured cervical vertebra, a severely fractured pelvis, or a haemothorax. Once the initial survey is complete, x-rays can be taken of the limbs to assess for other possible fractures. It is also quite common in severe trauma for patients to go straight to CT

Computed tomography

X-ray computed tomography or Computer tomography , is a medical imaging method employing tomography created by computer processing...

 or a surgery theatre

Operating theatre

An operating theater was a non-sterile, tiered theater or amphitheater in which students and other spectators could watch surgeons perform surgery...

 if they require emergency treatment.

ECMO can be effective in treating some polytrauma patients with pulmonary or cardiopulmonary failure.

A retrospective study of 93 children (average age of 8.0 +/- 4.1 years) with polytrauma and at least one major musculoskeletal injury showed that 80% of the incidents had been caused in this way (motor vehicle accident).

Military medicine

Overview

Polytrauma often results from blast injuries sustained by improvised explosive devices, or by a hit with a rocket-propelled grenade, with "Improvised explosive devices, blasts, landmines, and fragments account[ing] for 65 percent of combat injuries...". The combination of high-pressure waves, explosive fragments, and falling debris may produce multiple injuries including brain injury

Traumatic brain injury

Traumatic brain injury , also known as intracranial injury, occurs when an external force traumatically injures the brain. TBI can be classified based on severity, mechanism , or other features...

, loss of limbs

Amputation

Amputation is the removal of a body extremity by trauma, prolonged constriction, or surgery. As a surgical measure, it is used to control pain or a disease process in the affected limb, such as malignancy or gangrene. In some cases, it is carried out on individuals as a preventative surgery for...

, burns

Burn (injury)

A burn is a type of injury to flesh caused by heat, electricity, chemicals, light, radiation or friction. Most burns affect only the skin . Rarely, deeper tissues, such as muscle, bone, and blood vessels can also be injured...

, fracture

Bone fracture

A bone fracture is a medical condition in which there is a break in the continuity of the bone...

s, blindness

Blindness

Blindness is the condition of lacking visual perception due to physiological or neurological factors.Various scales have been developed to describe the extent of vision loss and define blindness...

 and hearing loss, with 60 percent of those injured in this way having some degree of traumatic brain injury.

In some ways, the high incidence of polytrauma is in fact a sign of medical advancement, for in previous wars, soldiers with such multiple damage types simply did not survive in most cases, even if quickly transferred into hospital care. The downside is however that many of the victims, though surviving, will never fully regain their physical or mental form. They are also prone to psychological complications such as post traumatic stress disorder.

U.S. treatment

There are currently four rehabilitation centers in the US specialising in polytrauma (as of 2010). They are managed by the United States Department of Veterans Affairs

United States Department of Veterans Affairs

The United States Department of Veterans Affairs is a government-run military veteran benefit system with Cabinet-level status. It is the United States government’s second largest department, after the United States Department of Defense...

 and are located in Minneapolis, MN; Palo Alto, CA; Richmond, VA; and Tampa, FL. In addition to the actual intensive care insofar as still required, these hospitals mainly specialize in rehabilitative treatment

Physical therapy

Physical therapy , often abbreviated PT, is a health care profession. Physical therapy is concerned with identifying and maximizing quality of life and movement potential within the spheres of promotion, prevention, diagnosis, treatment/intervention,and rehabilitation...

. In addition the Department of Veterans Affairs has 18 polytrauma network sites, located throughout the country. As of April 2007, the Department of Veterans Affairs has treated over 350 service members in their inpatient centers.
The treatment and rehabilitative care for polytrauma patient

Patient

A patient is any recipient of healthcare services. The patient is most often ill or injured and in need of treatment by a physician, advanced practice registered nurse, veterinarian, or other health care provider....

s is a very extensive and time-consuming activity. The recommended staffing numbers (FTE = Full Time Equivalent) for six rehabilitation treatment beds are:

0.5 FTE - Physician Physician A physician is a health care provider who practices the profession of medicine, which is concerned with promoting, maintaining or restoring human health through the study, diagnosis, and treatment of disease, injury and other physical and mental impairments...  Discipline FTE Rehabilitation 5.5 FTE - Registered Nurse (1.0 must be CRRN) 4.0 FTE - Licensed Practical Nurse and/or Certified Nursing Assistant 0.5 FTE - Nurse Manager 0.5 FTE - Clinical Case Manager, Admission and Follow-up 1.0 FTE - Social Worker Case Manager 0.5 FTE - Social Worker

1.0 FTE - Speech-Language Pathologist 1.0 FTE - Physical Therapist Physical therapy Physical therapy , often abbreviated PT, is a health care profession. Physical therapy is concerned with identifying and maximizing quality of life and movement potential within the spheres of promotion, prevention, diagnosis, treatment/intervention,and rehabilitation... 1.0 FTE - Occupational Therapist Occupational therapy Occupational therapy is a discipline that aims to promote health by enabling people to perform meaningful and purposeful activities. Occupational therapists work with individuals who suffer from a mentally, physically, developmentally, and/or emotionally disabling condition by utilizing treatments... 0.5 FTE - Recreation Therapist Recreational therapy Recreational therapy, also referred to as recreation therapy and therapeutic recreation, is a treatment service that provides treatments and recreation activities to individuals with illnesses or disabling conditions to improve or maintain physical, mental and emotional well-being and help reduce... 0.5 FTE - Counseling Psychologist Psychotherapy Psychotherapy is a general term referring to any form of therapeutic interaction or treatment contracted between a trained professional and a client or patient; family, couple or group... 0.5 FTE - Neuropsychologist Neuropsychology Neuropsychology studies the structure and function of the brain related to specific psychological processes and behaviors. The term neuropsychology has been applied to lesion studies in humans and animals. It has also been applied to efforts to record electrical activity from individual cells in...

In other words - 2.8 people are required full time (24h), for every patient, often for months, while some care may be required for life.