According to popular studies, the attempted resuscitation of patients in traumatic cardiac arrest in the prehospital care environment should not be pursued due to undo risk to the provider and has been shown to be ineff ective. However, after review of current literature, Sherren and colleagues developed and published in a recent edition of Critical Care a detailed treatment algorithm for their helicopter emergency medical service (HEMS) that encourages aggressive resuscitation for patients in traumatic cardiac arrest (TCA) [1]. What is known in a review of the quoted literature is that in the prehospital care environ ment, the survival rate of TCA patients is 0 to 3.7%, but in newer published studies survivability has risen to 7.5% [2,3]. What we already know is that prehospital medical cardiac arrest (MCA) survival is approximately 9.8%, with in-hospital cardiac arrest survival at 24.2% [4]. In MCA, chest compressions, defi brillation, medication, and oxygenation are the mainstay treatment tools. Where the TCA patient diff ers is that many do not have extensive co-morbidities or coronary artery disease; their arrest is primarily due to one of or a combination of factors: hypovolemia, obstruction of blood fl ow and hypoxia [5]. In the patient with thoracic trauma, these causes are addressed by well described techniques of thoracostomies, endotracheal intubation and blood products. Th is is followed by a clamshell thoracotomy, allowing for a better chance for hemorrhage control and treatment of hemopericardium if found. Sherren and colleagues discuss a very well outlined pathophysiology and rationale for TCA survivorship in their article. Although MCA and TCA are not the same diseases, their survival statistics are interesting and possibly some inference can be made when MCA data are more closely observed. It appears that the diff erences between MCA survival in the prehospital versus a hospital setting, where admitted patients are older with increased morbidities, might be due to the personnel performing the resuscitation. Staffi ng models for emergency medical services (EMS), especially for HEMS, diff er between the US system and the European model. In the US, pre-hospital EMS systems (including most HEMS) are staff ed by allied health professionals and not by physicians. In the European model (including Australia) HEMS are staff ed by well trained physician/paramedic/nurse teams and this is possibly where the diff erence occurs for survival for TCA patients. In multiple European studies it was noted that there was a decrease in mortality of trauma patients without a decrease in scene time when a physician was part of the fl ight crew [6-9]. In the US, less than 5% of HEMS are staff ed by physicians, and most of those involved in such teams are in their fi rst few years out of medical school [10]. Th us, no US EMS systems have fully trained physicians as part of their standard ambulance crew. A reasonable question to consider is whether staffi ng is the reason why TCA statistics diff er between the US and Euro...
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