Prehospital Doctors Add Little Value In Trauma

Dr Anthony HolleyEmergency Physician and Intensivist

Acknowledgements & Conflict

#MakePrehospitalCareGreatAgain

Prehospital Doctors Add Little Value In Trauma

Themes…..

This is my clinical realm

Call for Consensus on Methodology and Terminology to Improve Comparability in

the Study of Preventable Prehospital Trauma Deaths: A Systematic Literature

Review.

Acad Emerg Med. Oliver et al. 2016 Apr;23(4):503-10

Aggressive control of external haemorrhage

Airway - emergency anaesthesia

Thoracostomies/Thoracotomy

Warmed blood products

Experience/“Clinical judgement”

Critical Interventions

Event Frequency?

For anaesthesiologists, the Task Force commissioned by the Scandinavian Society of Anaesthesia and Intensive Care Medicine recommends endotracheal intubation.

Other physicians, as well as paramedics and other EMS personnel, are recommended the lateral trauma recovery position as a basic intervention combined with assisted mask-ventilation in trauma patients.

Proficiency of obtaining Grade I view at laryngoscopy was similar for physicians

(74.70%) and CCPs (77.36%).

After Dr Steve Rashford

With thanks from Dr Steve Rashford

The Hard Facts…..

• n = 25647• 701 (2.7%) “Life saving treatment”• 596 (2.3%) exceeded the competencies

of EMT• 225 (0.9%) ultimately discharged home

0.09%

Bareknuckleknockout

Prehospital doctorsaddlittle valueintrauma??

Conflictofinterest

Letsfaceit…

(most)(current)prehostpial EBMisB.S.

- Bias- Notoriouslydifficult- Methodologicallyflawed…

*BitScanty….Brilliantlysubjective....

Realityis:Wewant(ourpatientsdeserve)

Samelevel+standardofcareasINhospital

Realityis:Wewant(ourpatientsdeserve)

Seamlesspatientjourney

Thebeginning(ortheend)ofthetraumachainofsurvival…

Prehospital doctorsinthefield

Prehospital doctorasTraumaTeamleaders

Prehospital doctor(s)inthetraumabay

PrehospitaldoctorsinOR

Gas-docs

PrehospitaldoctorsinOR

Surgeons

PrehospitalICUdoctors

Familyphysicians,Cardiologist,neonatologist

Bridgesnotwalls

LEADERSHIP

KNOWLEDGE

ADDITIONALSKILLSANDTRAINING

DECISIONMAKING

ANTICIPATEDCLINICALCAUSE

INNOVATION

COLLABORATION

VISION

Prehospital teams

Hospitalteams

Researchteams

Simulationteams

unpublished‘truth’

EVERYDAY

ALLOVERTHEGLOBE

PREHOSPITALDOCTORS

AREHELPINGTOSAVELIVES

Don’ttakemywordforit…

Legionofextraordinary gentlemenandgentle-ladies

…weAREmany

...weCAREalot

Youdaresayweaddlittle….?

Really?REALLY?No,Isay,

“aHELLofaLOT” doesn’tevencoverit

“Honourableintentions”“Meaningfulinterventions”

Dr. JohnHinds(1980- 2015)