Patient rescue and transportation

This chapter provides the principles of patient rescue and transportation. It starts with immobilization and extrication, and then goes on to look at types of extrication (conventional, rapid, and snatch rescue), the principles of immobilization (prevention of further injury, pain relief, reduction of blood loss and the incidence of fat emboli, and facilitation of rescue), before going on to examine methods. It includes extrication devices, transport in pre-hospital care, and the benefits and risks of different sorts of vehicles.

Poisoning

This chapter begins by describing the approach to the poisoned patient, including airway, breathing, circulation, disability, and exposure. Differential diagnoses and those that should be excluded are explained. Diagnostic clues and symptom complexes are tabulated. Different poisons are then covered in turn, with their general and clinical features and management strategies detailed. A second section on substance abuse follows. The presentation and management of commonly abused drugs are described, alongside a dictionary of street names.

Trauma

This chapter starts with assessment and treatment of the time-critical trauma patient. It describes the primary survey in detail, with clear highlighted sections on areas of express concern or danger. The ‘two Hs’ and ‘two Ts’ of traumatic cardiac arrest are fully covered. The secondary survey is outlined, before moving on to specific forms of trauma and management. Head and neck injuries, maxillofacial injuries, chest injuries, abdominal and genitourinary trauma, bone and joint injuries are all covered, including causes, treatment, and potential problems. Regional injuries are then covered, including the upper limb, the wrist, finger fractures, pelvic injuries, and the lower limb. Complications of fractures are explained. Soft tissue injuries are also covered by region. Human and animal bites and tetanus-prone wounds, spinal injuries, amputation, blast and gunshot injuries, burns, and inhalation injuries are also explained.

Emergency obstetrics, gynaecology, and care of the newborn

This chapter starts with the anatomy and physiology of pregnancy and the approach to managing a severely ill or injured pregnant patient. It covers taking a history and examination, before describing the management of specific issues. These include shock, ectopic pregnancy, miscarriage, toxic shock syndrome, antepartum haemorrhage, placental abruption, hypertensive disorders (eclampsia and pre-eclampsia), pre-term labour, trauma in pregnancy, and normal labour. The chapter goes on to goes on to describe the retained placenta, abnormal labour, and normal birth. Neonatal resuscitation, and the circumstances in which it should be stopped, are explained.

Chemical, biological, radiological, and nuclear incidents

A chemical, biological, radiological, or nuclear (CBRN) incident may occur as the result of an accident or specific act of terrorism. Events such as the Chernobyl nuclear incident in Ukraine, the Sarin gas release on the underground system in Tokyo, the anthrax releases in the US, and the Salisbury Novichok attack, highlight the necessity for a structured multi-agency and multi-disciplinary response of which medical support is an essential component. This chapter covers the mode of presentation, and then focuses on each type in turn. Scene safety, triage, and information gathering are described. For chemical incidents, decontamination and specific antidotes are also included. Characteristics of biological agents are defined, and methods of managing a radiation and nuclear incident are specifically covered, including managing the patient.

The hostile environment

Pre-hospital care and emergency medicine in the hostile environment poses particular challenges for those providing care to the patient. This chapter covers hypothermia, cold injury, avalanche rescue, heat-related illness, drowning and near drowning, diving emergencies, and electrocution injury. For each environment, mechanisms, diagnosis, and management are listed.

Child health

This chapter covers managing the acutely ill or injured child. It starts with taking a history from a child, and ways of communicating with the child. Direct questions to ask from carers are also listed. The assessment of children is detailed, and recognition of <C>ABC problems is covered, alongside the management of ABC emergencies. Paediatric emergencies and their treatment are explained, and life support of children is included. Trauma in children (the leading cause of death in children over 1 year of age) and management, consent, analgesia, and child abuse and neglect are all contained in this chapter. Finally, paediatric drug doses are tabulated.

Formulary

This chapter describes the drugs most commonly used in pre-hospital care. As a result, it is restricted to indications which are likely to be encountered in the pre-hospital management of patients and only describes formulations which are used in these circumstances. For example, the use of oral amiodarone is not discussed, neither is the use of oral steroids in the management of chronic inflammatory conditions, although intravenous steroids in acute asthma and anaphylaxis are mentioned. Significant acute side-effects are listed.

Acute psychiatric emergencies

This chapter covers acute psychiatric emergencies and the associated legal and care-related issues. It begins with patient assessment with both a mental and physical examination checklist. It lists the common organic causes of psychiatric illness, available local services, and risk factors for successful suicide attempts. The presentation and management of different psychiatric conditions is described, including psychosis, depression, mania, anxiety disorders, and personality disorders. The legal and ethical issues, including the 1983 and 2007 Mental Health Acts, are explained. Methods of managing the violent patient are also described.

Major incident management and triage

The management of major incidents and disasters is complex and requires the effective engagement and integration of a great number of responding organizations and individuals. This section offers an introduction to the subject, clarifying the key principles and giving some basic organizational information. The chapter classifies major incidents, defines the specific phases, the process of declaring a major incident, how to set the scene (including command structures and responsibilities), explains the role of the health services, the roles of the other emergency services and the armed forces. It covers radio voice procedure and approved communication shorthand, triage, trauma scoring, and mass gathering medicine.