Articles: emergency-medical-services.
-
Emerg. Med. Clin. North Am. · Feb 1990
ReviewThe impact of emergency medical helicopters on prehospital care.
Emergency medical helicopter services have grown exponentially over the past seventeen years. These services offer rapid transport by flight crews to tertiary care centers with a higher level of medical capabilities. An impact because of helicopters on survival has been well-documented for trauma patients. Assessing usage for other critical care patients remains to be delineated further.
-
Prehospital advanced trauma life support (ATLS) is controversial because the risks, benefits, and time required to accomplish it remain unknown. We studied 70 consecutive patients with penetrating cardiac injuries to determine the relationships among prehospital procedures, time consumed in the field, and ultimate patient outcome. Thirty-one patients sustained gunshot wounds, and 39 had stab wounds. ⋯ There was no correlation between on-scene time and either the total number of procedures performed (r = .17, P = .17) or IV lines established (r = .06, P = .6). On-scene times did not differ regardless of whether endotracheal intubation or pneumatic antishock garment applications occurred. We conclude that well-trained urban paramedics can perform multiple life-support procedures with very short on-scene times and a high rate of patient survival and that prehospital trauma systems require a minimum obligatory on-scene time to locate patients and prepare them for transport.
-
Published reports of out-of-hospital cardiac arrest give widely varying results. The variation in survival rates within each type of system is due, in part, to variation in definitions. To determine other reasons for differences in survival rates, we reviewed published studies conducted from 1967 to 1988 on 39 emergency medical services programs from 29 different locations. ⋯ Hypothetical survival curves suggest that the ability to resuscitate is a function of time, type, and sequence of therapy. Survival appears to be highest in double-response systems because CPR is started early. We speculate that early CPR permits definitive procedures, including defibrillation, medications, and intubation, to be more effective.
-
In the development of triage and bypass protocols, many different scoring systems and triage criteria are being used. Our purpose was to evaluate the Revised Trauma Index (RTI) as a triage tool for both its severity prediction ability and triage accuracy. A total of 2,340 trauma admissions were evaluated using the RTI and the Injury Severity Score (ISS). ⋯ There is 5% death rate at an RTI level of 15, which yields a 5% undertriage rate for death and a 37.3% overtriage rate for predicting an ISS greater than 15. This compares to under and overtriage rates for the Trauma Score, CRAMS, Pre-Hospital Index, and Mechanism of Injury scales varying from 19% to 56% undertriage and 7% to 82% overtriage. We reached the following conclusions. a) The RTI is a simple, fast triage tool for predicting major trauma. b) The RTI is related to the ultimate ISS. c) Use of an RTI greater than or equal to 15 results in an acceptable undertriage rate, with a better rate for overtriage than existing scores. d) Therefore, we recommend the RTI for use in emergency medical direction and bypass protocols.
-
A Pediatric Trauma Score (PTS) was recently developed and is rapidly gaining acceptance as a triage tool. This study examines the utility of the PTS as compared with the Revised Trauma Score, which is applicable to all ages. The charts of 376 children 0 to 14 years of age who were admitted to the trauma service of a level 1 trauma center were reviewed. ⋯ Triage accuracy was 68.3% for the PTS and 78.8% for the Revised Trauma Score. The Revised Trauma Score is easy to use and universal in its applicability. The PTS involves learning a separate scoring system and is of no advantage.