Emergency management of severe polytrauma with traumatic diaphragmatic hernia via EMSS: case report and literature review

Introduction: Traumatic diaphragmatic hernia (TDH) frequently results from high-energy trauma and is commonly associated with severe polytrauma, presenting significant diagnostic challenges. This report highlights the role of an integrated emergency medical services system (EMSS) in managing these complex cases. Case Presentation: A 56-year-old male was admitted following a motor vehicle accident. Despite prehospital resuscitation by the EMSS team, he presented with decompensated hemorrhagic shock. Persistent cardiorespiratory instability prompted computed tomography (CT), which revealed left TDH, liver laceration, pulmonary contusion, and multiple fractures. The unified trauma team performed damage control surgery. Postoperatively, the patient developed severe acute respiratory distress syndrome (ARDS) in the emergency intensive care unit, requiring massive transfusion and advanced ventilatory support. After stabilization, he underwent definitive orthopedic surgery and recovered without significant sequelae. Discussion: TDH is easily overlooked in polytrauma patients due to a nonspecific presentation. Early diagnosis and surgical intervention are critical. The integrated EMSS model - featuring coordinated prehospital care, in-hospital resuscitation, damage control surgery, intensive care, and definitive surgery by a single team - was instrumental in achieving a successful outcome. This approach ensures continuity of care and reduces missed diagnoses. Conclusion: Timely recognition and management of TDH in polytrauma are essential. While surgery remains the cornerstone treatment, vigilance for postoperative complications like ARDS is crucial. The EMSS model provides an effective framework for managing these critically injured patients.