Emergency medicine clinics of North America
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The past two decades have been a period of increased concern over the improvement of prehospital emergency medical care. Training of basic and advanced EMTs to a level of professionalism that includes a distinct body of knowledge and the use of assessment and management skills is only one component of the prehospital system. ⋯ The management of the trauma victim is an organized plan of controlling the airway, restoring breathing, and supporting ventilation, followed by a secondary survey of the less life-threatening problems. The role of EMTs or paramedics, therefore, is to assess, manage, extricate, and transport.
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It has been estimated that one fourth to one third of the deaths from trauma could be prevented by more effective initial care. The majority of traumatized patients who present to the emergency department do not have life-threatening injuries and may be assessed in an orderly manner. Roughly 10 per cent of patients will have life-threatening injuries, however, and speed in assessment, diagnosis, and therapy is crucial to their survival.
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Maxillofacial injuries are frequent, often dramatic, and easily divert attention from more occult injuries. Early consultation with the plastic surgeon will enable the traumatologist to formulate an integrated, definitive plan that will produce superior aesthetic and functional results.
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In summary, I have examined the questions of why have a trauma care system and whether trauma care systems improve trauma care. I believe the evidence is overwhelming that trauma care systems are worthwhile and that they improve trauma care. ⋯ Trauma care systems should also be integral to the regional disaster plans and to the education of the public and should be a focus for research activities in trauma care. All trauma centers should provide access to rehabilitation services so that the patient who recovers from acute injuries can return to a productive life.
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Injury to the chest accounts directly or indirectly for up to 50 per cent of deaths secondary to trauma. Eighty-five per cent of patients with chest injury may be managed by minor procedures available to the emergency physician. The indications for surgery in the remaining 15 per cent of patients with chest injury must be understood.