Distracting Injuries: Pulling Focus and Masking Pain

/ Delta Emergency Support Training/

When trauma calls come in, it’s easy to fixate on the most obvious wound, the open fracture, the deep laceration, the heavy bleeding. But those are often distracting injuries: visible traumas that can obscure other, more dangerous threats. Recognizing them and continuing to assess systematically is what separates a good response from a lifesaving one.

What Is a Distracting Injury?

A distracting injury is one that draws your attention so strongly that both responders and patients may overlook other serious but less obvious issues. In paramedic protocols, these injuries can make a patient “unreliable” for clinical clearance of the cervical spine because they may mask neck pain or tenderness. As a result, spinal precautions should be maintained unless more definitive assessment rules them out.

Why They Matter

The danger of distracting injuries is twofold:

  1. They pull focus – A gruesome fracture or large bleed grabs everyone’s attention, often overshadowing a more subtle but life-threatening issue like a compromised airway or spinal injury.

  2. They mask pain – A patient in severe pain from a major injury may not report or even notice neck or back pain, leading responders to miss critical red flags for spinal trauma.

    Evidence-Based Insights

    Studies show distracting injuries are often upper-torso or limb injuries that change how a patient perceives or reports pain:

    • Heffernan et al. (2005) found that some patients with cervical spine fractures had no neck tenderness—but all had upper torso injuries like chest trauma, which likely distracted from the pain.

Common Examples

  • Long bone fractures (femur, humerus)

  • Major burns

  • Crushing or degloving wounds

  • Profuse bleeding or amputations

  • Severe chest or upper torso injuries

First Responder Priorities

  1. Stick to the primary survey (ABCs)
    No matter how distracting a wound looks, airway, breathing, and circulation must always come first.

  2. Protect the spine when in doubt
    If a distracting injury is present, assume the patient cannot reliably clear their spine. Apply spinal precautions unless imaging or protocols say otherwise.

  3. Reassess constantly
    A distracting injury may not only occupy the patient’s attention but yours as well. Don’t let tunnel vision take over.

  4. Think systematically, not emotionally
    The most dramatic injuries are not always the deadliest. Quiet but hidden injuries like internal bleeding or spinal cord compromise, may be far more dangerous.

The Bottom Line

Distracting injuries are more than just dramatic wounds—they can hide life-threatening problems and mislead both responders and patients. The best protection is discipline: follow a structured assessment, protect the spine when necessary, and never let your focus shift entirely to the injury that looks worst. A calm, systematic approach can make the difference between managing trauma and saving a life.