Articles: emergency-medical-services.
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Tidsskr. Nor. Laegeforen. · Feb 1992
[Treatment at the site of the accident and transport of patients with multiple injuries].
In the event of an accident it is the responsibility of the public health service to attempt to save lives, and to reduce pain and permanent disability. This is done by a complex chain of actions by persons ranging from the provider of first aid to the rehabilitation team. ⋯ Paramedics, primary care doctors and specialized emergency care teams are all important collaborators in this field. The specific decisions that are made at the various stages of treating a patient with multiple injuries will always be of fundamental importance for the patient.
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Mortality from severe multitrauma is 25-30%. Haemorrhage is the cause of one third of the deaths, either directly or indirectly as the cause of organ failure. Many trauma victims will not present alarming symptoms shortly after the accident. ⋯ Due to risk of overlooking injuries, patients should not be sorted by surgical specialty in the field. Obstructed airways are more acutely life-threatening than inadequate respiration, which is more serious than decreased circulation, which is again more dangerous than impaired consciousness. In general, thoracic injuries take priority over abdominal, cerebral and orthopaedic injuries, in that order.
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Prehospital and resuscitation periods and times to emergency surgery were studied in major trauma victims over two 12-month periods to identify factors causing delay in emergency care. Eighteen patients required emergency surgery in the first group and 13 in the second. ⋯ Causes of delay included a sequential approach to resuscitation and investigation, limited staff and theatre availability, and failure to call the trauma team. Times for resuscitation and times to surgery could be reduced by earlier decision-making, alerting key personnel promptly and performing tasks in parallel.