Articles: emergency-medical-services.
-
Comparative Study
A controlled trial of prehospital advanced life support in trauma.
We compared the outcome of 472 trauma patients who required ambulance attention and who received prehospital advanced life support (ALS) with another similar 589 patients who received only basic life support (BLS). Nontrapped, critically injured ALS patients were treated for an average of 13 minutes at the scene of injury, compared with 17 minutes for BLS cases (P less than .05). Seventeen of 37 ALS deaths (36%) occurred within 24 hours of injury, compared with 24 of 33 BLS fatalities (73%) (P less than .05). ⋯ ALS care appeared to influence patient outcome during the first 24 hours after injury, but had little impact on the later clinical course. Our sample size was too small to rule out any effect of ALS on in-hospital mortality. However, the improved 24-hour survival associated with ALS care suggests some benefit of prehospital resuscitation in major trauma.
-
Comparative Study
Factors improving survival in multisystem trauma patients.
This report analyzes the effect of air versus ground interhospital transport on survival following multisystem injury. There were 136 air-transported patients versus 194 ground-transported patients. The groups were similar in trauma scores, ages, mechanism of injury, and organ systems injured. ⋯ However, helicopter charges met only 15% of the operational budget of the aeromedical service. The remainder of the costs were generated from hospital patient revenues. Overall, total hospital charges were similar for both groups and were influenced by the variability of length of stay, particularly for orthopedic patients.
-
From our emergency department logbook we identified 281 consecutive patients transported to the Regional Medical Center at Memphis following failed prehospital advanced cardiac life support (ACLS). Medical records were obtained for 240 cases (85.4%). Initial cardiac rhythms in the ED included ventricular fibrillation or pulseless ventricular tachycardia (29%), electromechanical dissociation (18%), and asystole (51%). ⋯ Both are presumed to have died. Failure to respond to prehospital ACLS predicts nonsurvival and may warrant cessation of efforts in the field. Future programs and research efforts in the management of out-of-hospital cardiac arrest should be focused on optimal provision of prehospital care prior to the onset of irreversible deterioration.
-
Thirty-two of 123 patients admitted to the Victorian Spinal Injuries Unit, Austin Hospital, during the period 1st March 1983 to 28th December, 1984 sustained major neurological deterioration from the time of injury to the time the patient was admitted to the Unit. The key to the prevention of major neurological deterioration in patients who have only vertebral column damage and in patients who have partial neurological dysfunction is a theoretical and practical understanding of the spinal column and cord. Suspicion about the possibility of spinal cord injury, followed by appropriate handling and immobilisation of these patients by treating personnel as soon as possible after the injury, could make major neurological deterioration before admission to a specialised spinal injuries unit a rare event.