Prehospital Trauma Care

Author(s):  
SM Sharma

ABSTRACT The global human population is spread all over the world, but cities, towns, and large villages have dense concentrations of human inhabitation. The inhabitants of cities and towns do have easy and satisfactory access for the management of traumatized patients. However, trauma victims in remote and distant regions, generally, do not have ambulance services or treatment centers nearby to deal effectively with injuries. Even on highways, at accident sites, the injured may succumb to the injuries due to delay in rescue and nonavailability of vital basic life support compounded by delay in transportation of the patient to appropriate hospital or dedicated trauma center. Other factors which add to mortality are nonavailability of trained and experienced personnel at the accident site, inadequate and improper resuscitation during transportation, and referral to a hospital ill-equipped to treat traumatized patients. Trauma is the leading cause of death for patients in their first four decades of life. Prehospital trauma care to save life has not received the necessary attention in developing world due to diverse reasons, including lack of trained staff, inadequate funding, lack of awareness, ignorance, lack of will, and unpredictability of occurrence of accidents. Trauma management remains neglected in third world countries; however, the developed countries have made continuous efforts to save lives of traumatized patients by systematized prehospital care at the site of accident, rescue, and extrication of victims, rendering lifesaving resuscitation on the spot and quick and safe evacuation of the patients to trauma centers by surface and air ambulances depending upon the terrain and distance of the site of occurrence from hospital with continuous monitoring of the patient onboard. Prehospital trauma care needs focused attention to evolve a system and institutions which would impart care to the wounded inclusive of rescue, resuscitation, stabilization of vital parameters, and safe transportation to a dedicated hospital to save life and prevent morbidity. How to cite this article Sharma SM. Prehospital Trauma Care. Int J Adv Integ Med Sci 2016;1(4):158-163.

Author(s):  
Adonis Nasr ◽  
Phillipe Abreu-Reis ◽  
Iwan Collaço ◽  
Flavio Saavedra Tomasich

ABSTRACT Background It is not always that prehospital trauma life support (PHTLS) principles are applied to daily practice. Lack of training to health care providers and a high amount of patients overwhelming the system capacity may let malpractice behavior to happen. It is the aim of this study to assess injuries misdiagnosed by prehospital trauma care in a capital city in southern Brazil. Study design A prospective observational non-controlled study with 174 random trauma cases that were brought to a level 1 trauma center in the city of Curitiba, between May 28th and June 10th 2006. We analyzed data registered in the prehospital rescue team form. The including criteria were all patients delivered to the trauma center by ambulances. The excluding criteria were patients not transported by ambulances and those without the proper form filled out. Statistical analysis was performed using the Chi-square for discrete, and the students’ t-test for continuous variables. Results Of the 174 patients who met the including criteria, 75% were men with a mean age of 27-year-old. Of the 11 injuries to the neck identified in the Hospital evaluation, eight were missed by the prehospital care (OR 0.26 CI 95% 0.07-0.94). Also, only 7/20 injuries to the back were identified by the PHTLS team (OR 0.32 CI 95% 0.13-0.78). Similarly, only 6/26 injuries to the chest (OR 0.20 CI 95% 0.08-0.50), 4/15 to the abdomen (OR 0.24 CI 95% 0.08-0.76), 4/16 to the pelvis (OR 0.23 CI 95% 0.07-0.70), 13/33 to the upper body (OR 0.34 CI 95% 0.17- 0.68),7/39 to the lower body (OR 0.14 CI 95% 0.06-0.33) and 17/55 (OR 0.23 CI 95% 0.12-0.42) were correctly identified in the prehospital scenario. Conclusion Although it is known PHTLS principles, which save lives when applied in practice, further training and remarks to its importance is needed to fully implement efficient trauma systems. Electronic data collection shall make checklists consistently filled out, so that patient care will be improved. How to cite this article Abreu-Reis P, Nasr A, Tomasich FS, Collaco I. Misdiagnosed Injuries in the Prehospital Trauma Care: Better Training needs to be Implemented. Panam J Trauma Crit Care Emerg Surg 2014;3(3):93-96.


Author(s):  
P. Pushpangadan ◽  
T. P. Ijinu

Rich biodiversity and equally rich cultural heritages are the two invaluable assets of most of the Third World Counties (TWC). Biogenetic resources are the primary source of valuable genes, chemicals, drugs, pharmaceuticals, natural dyes, gums, resins, enzymes or proteins of great health, nutritional and economic importance. Biodiversity regulates and maintains overall health of the life support systems on earth and is the source from which human race derives food, fodder, fuel, fibre, shelter, medicine and raw material for meeting his other multifarious needs and industrial goods required for the ever changing and ever increasing needs and aspirations. TWC members are still at the receiving end as far as the development of special value added products and herbal technologies are concerned. The developed countries, on the other hand, are emerging as super powers with their biotechnological strength. IPRs emerged strongly during the industrial revolution and it has been an important driving force behind rapid industrial growth and prosperity of the Western countries during the last 3 centuries. Nowadays Access and Benefit Sharing issues have become a central theme for subsequent detailed discussions and decision making under CBD, TRIPS and the WIPO. It is therefore increasingly urgent for the CBD to make ABS work as was intended. The entry into force of the Nagoya Protocol represents a step in this direction. In India, we can be proud of having the distinction of the first country in experimenting a benefit-sharing model that implemented in Letter and Spirit Article 8(j) of CBD.


2019 ◽  
Vol 34 (s1) ◽  
pp. s104-s104
Author(s):  
Stanislav Gaievskyi ◽  
Colin Meghoo

Introduction:The public ambulance system in Ukraine is the primary deliverer of prehospital care for trauma patients in this Eastern European country, but no national assessment has previously been made to ensure the presence of essential medical equipment on these ambulances.Aim:Working with the Ukraine Ministry of Health, our aim was to assess the availability of public ambulances of medical equipment essential for managing traumatic injury using an internationally recognized standard for prehospital care.Methods:We identified 53 Advanced Life Support (ALS) ambulances from randomly selected cities for evaluation. We performed an inventory of available medical equipment and supplies on these ambulances against a matrix of essential equipment for prehospital providers developed by the World Health Organization (WHO).Results:Essential medical equipment in the categories of personal protection, patient monitoring, hemorrhage control, and immobilization were generally available in the ALS public ambulances surveyed. Deficiencies were noted in equipment and supplies for basic and advanced airway monitoring and management.Discussion:Public ALS ambulances across Ukraine are adequately equipped with many essential medical supplies to manage traumatic injury, but have deficiencies in both basic and advanced airway management. Correcting these deficiencies may improve prehospital survival of the traumatically injured patient. The results of this study will enable the Ukraine Ministry of Health to develop requirements of essential medical equipment for all public ALS ambulances in the country, to inform resource allocation decisions, and to guide public health policy regarding prehospital trauma care.


2004 ◽  
Vol 19 (04) ◽  
pp. 318-325 ◽  
Author(s):  
Carlos Arreola-Risa ◽  
Charles Mock ◽  
Alejandro J. Herrera-Escamilla ◽  
Ismael Contreras ◽  
Jorge Vargas

AbstractIntroduction:In Latin America, there is a preponderance of prehospital trauma deaths. However, scarce resources mandate that any improvements in prehospital medical care must be cost-effective. This study sought to evaluate the costeffectiveness of several approaches to improving training for personnel in three ambulance services in Mexico.Methods:In Monterrey, training was augmented with PreHospital Trauma Life Support (PHTLS) at a cost of [US]$150 per medic trained. In San Pedro, training was augmented with Basic Trauma Life Support (BTLS), Advanced Cardiac Life Support (ACLS), and a locally designed airway management course, at a cost of $400 per medic. Process and outcome of trauma care were assessed before and after the training of these medics and at a control site.Results:The training was effective for both intervention services, with increases in basic airway maneuvers for patients in respiratory distress in Monterrey (16% before versus 39% after) and San Pedro (14% versus 64%). The role of endotrachal intubation for patients with respiratory distress increased only in San Pedro (5% versus 46%), in which the most intensive Advanced Life Support (ALS) training had been provided. However, mortality decreased only in Monterrey, where it had been the highest (8.2% before versus 4.7% after) and where the simplest and lowest cost interventions were implemented. There was no change in process or outcome in the control site.Conclusions:This study highlights the importance of assuring uniform, basic training for all prehospital providers. This is a more cost-effective approach than is higher-cost ALS training for improving prehospital trauma care in environments such as Latin America.


Author(s):  
Adonis Nasr ◽  
Phillipe Abreu-Reis ◽  
Iwan Collaço ◽  
Flavio Saavedra Tomasich

ABSTRACT Background Trauma registry remains a great problem to most countries that are implementing trauma systems. Nondigital data assessment and storage may lead to information deterioration along the process. In order to verify the missing registry in prehospital trauma rescuers’ form, we ran this study. Study design A prospective observational noncontrolled study with 288 random trauma cases brought to a Level 1 Trauma Center in Curitiba, between May 28th and June 10th 2006. We analyzed data registered in the prehospital rescue team form. The including criteria were all patients delivered to the trauma center by ambulances. The excluding criteria were patients not transported by ambulances and those without the proper form filled out. Statistical analysis was performed using the Chi-square for discrete, and the student's t-test for continuous variables. Results Two hundred and eighty-eight trauma cases were observed. Twelve patients were excluded. Of the 276 patients who met the including criteria, 75% were men with a mean age of 27-year-old. In only 8.34% of times patients were brought by doctors, while in 91.66% by paramedics. 63.4% of patients were traffic injuries victims, followed by 12.31% falls, 6.52% falls from the high, 5.79% gunshot wounds, 5.34% assaults, 3.62% stab wounds, 2.89% others. Impressively, 16 patients (5.89%) had no records of respiratory rate from the prehospital care assessment, 20 (7.24%) had no data of systolic blood pressure and 13(4.71%)had no pulse registry. Furthermore, 31.25% of the RR not registered were abnormal in the hospital admission evaluation, as well as 15% of the SBPs, and 23% of HR. None of the cases had information regarding time from the scene to the hospital. Conclusion Electronic data collection shall make checklists consistently filled out. It is not well understood the importance of registering data for most of healthcare providers working in the field, especially when they do not follow the in-hospital care of trauma patients. How to cite this article Abreu-Reis P, Tomasich FS, Nasr A, Collaco I. Prehospital Trauma Care Registry Problems in South Brazil. Panam J Trauma Crit Care Emerg Surg 2014;3(3):97-100.


Author(s):  
Jameel Ali ◽  
Rasheed U. Adam ◽  
Theophilus J. Gana ◽  
Henry Bedaysie ◽  
Jack I. Williams

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