ISSN:0969-9546    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Previous studies on prehospital care are mostly hampered by a large number of less-urgent missions and lack of utilization of the possibilities which blur the effect of an advanced medical service. The current analysis of the most aggressive trauma care on-scene concludes that largely all vital stabilization can be carried out prehospitally, except performing an X-ray (with its possible consequences) and an operation. The latter measure does, however, also represent the current limits of field stabilization: circulatory unstable patients with penetrating bleeding trauma or presumed internal haemorrhagia will require a minimal stabilization - concentrating on securing the airway - and then fast transport to the nearest hospital with capability to carry out an acute operation (the 'scoop and run' principle). Novel principles and pathophysiological understanding indicate that new principles of field stabilization may actually offer further support and thereby increase the chances of survival for these patients, provided the necessary new techniques acknowledge the need 'for speed. In this development, the principles in prehospital care often exceeds what is actually offered in the hospitals' emergency rooms. Since the majority of advanced prehospital methods depends on comparatively safe anaesthesia and analgesia techniques, the particular responsibility for anaesthetists in this field is stressed.

ISSN:0969-9546    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

There is substantial evidence that with better investment of human and capital resources, better evacuation procedures, and more timely delivery of trauma victims to trauma centres, that mortality and morbidity from trauma will be reduced. The integration of these advances in care, as well as the need to avoid mistakes, requires sound decisions. Thankfully, a clear consensus of the priorities in assessment and intervention is available to guide caregivers as they make these decisions. Repeated examination of the patient and concerted use of these priorities, together with data collection to monitor their use will benefit patients.

ISSN:0969-9546    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Prehospital airway obstruction is common following traumatic injury. Airway management of these patients is difficult in the prehospital setting, particularly because those providing care are often not trained in the skills necessary for endotracheal intubation. As a result, a number of alternative devices are available for airway maintenance. Nevertheless, endotracheal intubation remains the gold standard in airway management. Although it provides the optimum airway and protects the airway from aspiration, its successful insertion requires regular training. Incorrect placement carries considerable risk. The laryngeal mask airway may be a suitable alternative for many situations and appears to be the best alternative to endotracheal intubation. Training in its use is straightforward and it is relatively easy to insert. Risks of aspiration appear small. The pharyngotracheal lumen airway and Combitube are both more difficult to use than the laryngeal mask airway and risk inflating the stomach if the devices are incorrectly used. Cricothyroidotomy is associated with serious complications but is only used where there is no other option. As with other techniques, it requires regular training in its use.

ISSN:0969-9546    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Management of the trapped casualty is a specialized area of prehospital care. It requires close cooperation between all the emergency services. Specific training courses are being developed in the UK for both rescue and medical teams. When approaching an entrapment incident medical teams must consider their own safety and liaise closely with the paramedical and rescue crews as to the best means of effecting casualty release. A variety of immobilization equipment is available, different equipment being suitable to different situations. The prehospital anaesthetist needs to understand the influence this equipment has on airway management and subsequent anaesthesia.

ISSN:0969-9546    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

For optimal treatment of burns an understanding of the pathophysiological changes occurring locally and systemically after injury is necessary. Accurate estimation of burn size and depth as well as early treatment is essential. Knowledge of the circumstances of the accident and experience in diagnosing physical signs are required in terms of the need for intubation, treatment of poisoning and the occurrence of other trauma.

ISSN:0969-9546    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

The unique physiologic and medical consequences of blast injuries are often unrecognized and frequently poorly understood. The medical consequences, including pulmonary, gastrointestinal and auditory injury, have a defined and unique set of physiologic sequelae. Understanding the mechanism of injury, treatment issues and the potential long-term morbidity of primary blast injuries will enhance survival.

ISSN:0969-9546    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

The need to consider the problem of acute toxic injury in the prehospital context emphasized by the recent use of highly toxic agents of warfare in terrorist attacks. Toxic agents differ widely in their nature but may be considered to have four distinct properties: toxicity, latency, persistency and transmissibility. Toxicity and latency determine the onset and pathophysiology of the poisoning and therefore the clinical management. Persistency and transmissibility determine the level of hazard to rescue personnel and the evacuation system and therefore the rationale of logistic management. Previously, special emphasis has been given to the importance of isolation and decontamination of the patient before any medical intervention can occur. This approach, however, although essential for the safety of medical responders may not be in the best interests of the patient who may be in a life-threatening situation within a contaminated zone (CONZONE). Toxic injury may require more rapid help than traumatic injury; moreover, traumatic and toxic injury may co-exist, as in the case of explosion with toxic emission. The special skills required are defined in the TOXALS™ programme and must now become a standard part of the training and practice of prehospital care medical care.

ISSN:0969-9546    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

The Great Hanshin earthquake on 17 January 1995 caused a complete disruption of both the communications and transportation systems which, as a result, severely hampered a prompt and timely system response. The survival rate of the extricated victims was 80.4% on the first day, and 1892 victims were extricated with an overall survival rate of 40%. Very few patients were transported to hospitals outside the disaster area on the first day of the disaster. The power supply was quickly reestablished, however, it took a long time for the water supply to return to normal and this factor played a major role in limiting the clinical activities of the damaged hospitals. Crush syndrome was the most prominent medical syndrome necessitating critical care after the Kobe earthquake. The Japanese Association for Acute Medicine has since made eight new proposals for emergency medicine during mass-disasters that will hopefully improve the survival of patients in any future disasters.

ISSN:0969-9546    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Setting standards and implementing quality improvement in trauma care needs consideration of the definitions of standards, guidelines, recommendations and the present quality of trauma care. Essential factors for consideration are the chain of survival and different intervals which may decide on patient outcome: (a) the trauma (occurrence) to trauma recognition interval which has, until now, not been taken into consideration with regard to morbidity and mortality; (b) the scene time is part of the total prehospital time which comprises rescuing the entrapped patient, preparation of the patient for treatment, and transfer to a rescue vehicle. The medical part of the scene time, however, represents only 25% of the total scene time and an even lower percentage of the total prehospital time. Correlating scene time with outcome and concluding that medical treatment at the scene may be detrimental to the patient are thus inaccurate suppositions. It has been shown that the quality of care is not always based on scientific evidence. This is the case for fluid administration, endotracheal intubation, etc. Furthermore, the qualification of the different personnel responding to trauma alert needs to be taken into consideration as well as the quality of care provided by the individual hospitals. The following conclusions may thus be drawn: that, currently there is no scientifically proven standard of care for trauma patients; the role of trauma care standards in the reduction of mortality and morbidity has not yet been identified; implementing incorrect standards may lead to entirely inappropriate conclusions; and that it is essential to perform scientific investigations of the outlined factors in order to establish future standards of trauma care.

ISSN:0969-9546    

出版商:OVID    

年代:1996

数据来源: OVID