Analgesia in the Field

Emergency Medical Services and the care of patients in the field have taken giant steps forward over the past decade. Born of the desire of physicians to influence the mortality rates of sudden cardiac death in the community, systems of advanced life support have taken root in the urban centers in the United Kingdom, Australia, the United States, and other countries (1-3). Although originally largely designed around the concept of “mobile coronary care,” these systems soon were deluged with calls for help from all sectors of the community, and faced a variety of medical problems. As trauma gradually became recognized for the killer and maimer of young lives that it is, regional programs of trauma care were developed in the United States and led gradually to the expansion of prehospital and interhospital transport systems in which critically injured patients were being moved about, often over long distances. The growth of emergency medicine as a specialty in its own right has encouraged the study and improvement of systems of disaster and mass casualty management.Although the focus of these efforts has been largely the overall reduction of death and disability in critically ill or injured patients, controversy continues around not only the extent of field intervention but also the influence of our efforts on the outcome of these patients (4, 5). The importance of particular interventions such as intravenous line placement, administration of certain medications, the use of the pneumatic anti-shock garment, and other sacred cows of prehospital care, all have been questioned of late (6, 7).