European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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Management of the trapped casualty is a specialized area of prehospital care. It requires close cooperation between all the emergency services. ⋯ 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.
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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. ⋯ 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 or 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.
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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%. ⋯ 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.
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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. ⋯ 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.
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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. ⋯ 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.