This is the first in series of short, case-based learning posts for trauma team leaders (TTL). These tips, based on our real-world experience with injured patients, will help you get the best out of your team when it matters most.
The alarm bell has just gone off in Triage. You rush across to find a twenty-one year-old man lying on the floor in the waiting area. He looks pale, and his Virchester United shirt is soaked with fresh blood.
Your nursing colleague informs you that he collapsed after being dropped off at the hospital by a “friend” who has since left.
Two bleeding wounds are visible on the patient’s right arm and neck. They look like stab marks. As you apply pressure, you think about where else this patient may have been injured…
What do I do?
Be thorough! Penetrating trauma patients need to be fully examined for hidden wounds, and if you use these three tips, you will be less likely to miss anything…
1. Check your blind spots
Look for hidden wounds in:
  •  Back
  •  Buttocks / natal cleft / anus
  •  Groin
  •  Axillae
  •  Beards and any areas obscured by hair
Remember that even small wounds can be associated with serious underlying pathology! We think that the first FOUR areas are well known and taught, but beards and hair are rarely mentioned. We know of cases where very significant injuries (even gunshot wounds) have been missed, notably in big bushy beards.
Also be careful to look in any areas that are covered in blood or blood clots. It’s easy to miss small wounds if there is overlying blood or clot. Wipe it away and ensure that you have not missed another hole in your patient.
2. Look as soon as you can
We recommend that patients are examined for hidden wounds as part of the primary survey and before they gets tied up with wires, catheters, infusion etc.
You will need to undress the patient, log roll them, and move limbs about to do this properly.
3. Double-check!
Look for additional injuries even if the pre-hospital team tell you that the patient has been fully examined at the scene.
Remember that you will have better lighting and more people available in Resus as compared to the prehospital setting.
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Greg Yates and Simon Carley
Download the pdf here.
About the Trauma Team Leader Series
The Trauma Team Leader (TTL) Series is edited by Prof. Simon Carley and Dr. Greg Yates, drawing on the collective experience of clinicians across St Emlyn’s and Virchester, working in both prehospital and hospital trauma care. Each piece explores a different aspect of leading in trauma — blending clinical insight, human factors, and team leadership.
These posts are based on our own experiences and reflections; they aren’t prescriptive, and we know that other teams and clinicians may approach things differently. We know that we do is not right for everyone, and that others will disagree. That’s great and it’s all part of the learning. If your practice varies, or if you’ve found better ways of doing things, we’d love to hear from you and share ideas through the St Emlyn’s community.
