European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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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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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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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.
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We report two cases of spontaneous life-threatening haemopneumothorax, successfully treated by early thoracotomy. In the first patient no source of bleeding could be identified. ⋯ The first patient benefited from early clot evacuation and in the second patient the bleeding could be controlled by electrocautery and a single suture of the bleeding vessel. These cases stress the need for early recognition and management of a potentially life-threatening event.