Effect of Prehospital Advanced Life Support on Outcomes of Major Trauma Patients

Abstract

ALS procedures can be performed by paramedics on major trauma patients without prolonging on-scene time, but they do not seem to improve survival.

Impact of pre-hospital oxygenation and ventilation status on outcome in patients with isolated severe traumatic brain injury

“…In most of these studies pre-hospital intubation was performed by non-physician prehospital personnel with limited ETI training and clinical skills and who did not have full access to the drugs used during RSI protocol. (7,8,20,21) It is likely that the patients who can be intubated in the field without RSI medications have a more devastating neurologic injury compared to those who need RSI medications and as a consequence less favorourable outcome. Increased mortality was observed even when patients with TBI underwent paramedic RSI, due to severe hypoxia and hyperventilation during paramedic RSI.…”

Timing of death at National Trauma Center, Abuja, Nigeria

“…Transportation is then provided in a large ground or air ambulance that is equipped with sophisticated monitoring devices, a wide range of medicines, and an array of communication devices. 27 These are expensive arrangements that are unlikely to be available to resource-constrained environments. However, Prehospital Trauma Care Systems 28 is a publication developed by the World Health Organization (WHO) that focuses on the most promising interventions and components of prehospital trauma care systems.…”

Prehospital Endotracheal Intubation: Elemental or Detrimental?

“…As a result, the procedure can be relatively easy to perform by highly-experienced care providers. However, using unqualified univariate analysis, ETI is typically performed in those patients with a high-risk of associated morbidity and mortality and thus can be simplistically correlated with a poor outcome [16][17][18][19][20]. Paradoxically, in some selected EMS systems, ETI has actually been correlated positively with survival, particularly in cases of post-traumatic circulatory arrest [7,8].…”

“…In a subsequent casecontrol study of severely head-injured patients receiving ETI that was facilitated by rapid sequence induction (RSI), outcomes were worse for patients receiving the procedure versus those with similar injuries not receiving it [25]. Also, in deference to other studies indicating a survival advantage to ETI in post-traumatic circulatory arrest [7,8], the on-going univariate association of ETI with mortality in recent studies, though predictable, has fueled the debate that ETI should no longer be used in the outof-hospital setting [16][17][18]23].…”