Essential role of prehospital care in the optimal outcome from major trauma

Abstract

Prehospital care for major trauma victims is a balance of timely delivery to definitive care and appropriate intervention to maximize probability of survival. In the development of advanced, organized prehospital care systems, the evidence for the benefit of individual interventions has been limited and contradictory. Leading controversies reviewed are: the place of advanced life support, the role of doctors compared with paramedics, the optimal advanced airway adjunct, the role of intravenous fluids in serious injury, and the value of prehospital cardiopulmonary resuscitation following traumatic cardiac arrest. International differences in trauma epidemiology are discussed. The identification of prehospital care as the weak link within a trauma system is highlighted.

Sobrevivência após acidentes de trânsito: impacto das variáveis clínicas e pré-hospitalares

“…9 Countless technological advances have been incorporated into trauma care worldwide, in an attempt to lower social costs and improve care for the victims. However, it is not always possible to see the actual impact of care on the victims' survival, once there are many factors involved in this result.…”

“…[8][9][10] However, to statistically verify the association between prehospital interventions and survival has been a diffi cult task for researchers worldwide, creating controversies over this resource's usefulness. 9,14 Instead of the fatality analysis, which examines the "alive or dead" dichotomy, survival analysis has been supported by researchers all over the world 6,7,10,13 to assess the prehospital care phase. Survival analysis considers survival time as a dependent variable and analyzes factors that may interfere with this result as independent variables.…”

“…Among these factors, there are aspects related to the victim and trauma mechanism, in addition to clinical aspects, such as the severity of injuries and their physiological repercussions, as well as the initial care provided. 9,10,[12][13][14] Among the technologies that have been employed in the initial care of the trauma patient, prehospital care stands out, [8][9][10][11] having two categories 11 -Basic Life Support, whose main characteristic is not to perform invasive, life-preserving procedures, and Advanced Life Support, which involves invasive procedures.…”

Emergency Medical Services Outcome Assessment in Lagos, Nigeria: Review of Cases of ‘’Brought in Dead‘’ Patients

“…It is established that prehospital transport is the weak link within a trauma system in both developed [1] and developing [2] countries. One index of measuring the efficiency and effectiveness of the prehospital transport is the number of ''Brought in dead'' (BID) patients presenting as dead in the hospital.…”

Fatores associados ao risco de lesões e óbito de motociclistas envolvidos em ocorrências de trânsito

“…A topografia plana e o predomínio de dias ensolarados, com temperaturas acima dos 20º, contribuem para incrementar a utilização deste tipo de veículo 12 [135][136][137] .…”