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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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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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.
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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.
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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.