What is Prehospital Care?
Prehospital care involves initial recognition and treatment of life-threatening injuries at first contact with patient.This may mean roadside examination and intervention in transporting ambulance.
After discovery of Golden Hour [ Victim’s chances of survival are greatest if they receive care within a short period of time after a severe injury], it was thought to provide the care to victim at first contact, wherever the victim may be.
Because substantial time is lost between transportation of the patient, concept of prehospital trauma care was developed. Basic aim is to recognize the injuries and intervene if necessary, enroute to the hospital.
Greek military operations show the earliest records of organized prehospital trauma care, including the advent of triage. [Triage is prioritizing the injury victims according to severity of injury.]
After the injuries have been recognized, the patient is evacuated to a center with adequate resources for definitive care.
Prehospital trauma care team may vary depending on the response needed, which in turn would depend on severity of the disaster. Prehospital trauma care can include just basic first responders or joined by paramedics and physicians.
Techniques have been developed to safely extricate injured patients from crumpled vehicles, damaged structures, and precarious geographic regions.
In a trauma victim, the order of priorities can be remembered as ABCDE. They are prioritized depending on the severity of the element and urgency to deal with it. Here is brief of what each letter signifies.
First priority is to confirm and establish a secure unobstructed airway.
85% of trauma patients are estimated to die of airway problems before they reach the hospital. Airway management is particularly critical following head injury, cervical spine, or thoracic trauma and takes precedence over other things including transportation [unless it can be done en route]
Orotracheal intubation, either with or without sedatives and paralytics, is the mainstay for airway management.
- Bag-valve-mask ventilation with jaw lift
- Oral or nasal airway
- Esophagotracheal combitube
- Laryngeal mask airway
- Nasotracheal intubation
- Percutaneous needle, or open cricothyrotomy.
Breathing is an activity responsible for dispensing oxygen to the lungs which then gets exchanged and is transported to the tissues. Breathing is next management priority after airway.
If the patient is awake, cooperative and has been found to have a stable airway, oxygen by face mask should suffice. However, the patient should be monitored closely for airway and ventilation.
Pulse oximetry is used for measuring oxygen hemoglobin saturation levels in prehospital patients and can guide on adequacy of breathing and ventilation.
One of the important aspect of prehospital management is recognition of life threatening injuries such as pneumothorax [air in thoracic cavity], pneumohemothorax [air and blood in cavity] and hemothorax [blood in thoracic cavity].
Along with hemothorax and flail chest, pneumothorax remains a significant cause of prehospital death.
Needle thoracostomy is the first line treatment for suspected tension pneumothorax.
Any major loss of circulation is dealt with and fluid resuscitation is done through intravenous access, fluid treatment, drug administration, and earlier access for transfusion upon arrival to the hospital.
Intravenous access is utilized in the prehospital setting include peripheral IV access, central venous access, and intraosseus access.
Rapid neurological assessment (is patient awake, vocally responsive to pain or unconscious).
Verbal response V
Painful response P
E—Extra information and Enviromental protection
Undress patient and look for injury. Extra information about patient that matters comes under this. If the patient is suspected of having a neck or spinal injury, in-line immobilization is important.
In the field, “E” stands for extra information like procedures performed and environmental protection (e.g., protect the patient from extremes of heat or cold), whereas in advanced life support, E stands for exposure and environmental control, meaning completely undress the patient, visualize all body surface areas, but prevent hypothermia.
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