Efficacy of prehospital critical care teams for severe blunt head injury in the Australian setting

Garner, Alan; Crooks, Jenelle; Lee, Anna; Bishop, Rod

doi:10.1016/s0020-1383(01)00013-4

Cited by 39 publications

(30 citation statements)

References 16 publications

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“…This is likely due to the inherent complexity of critical care interventions, which require extensive training, regular exposure and effective clinical governance to maximise benefits and minimise associated risks 20. An alternative approach, which has been adopted within GWAS and other ambulance services in the UK and internationally, is the concentration of training and clinical exposure for a small group of prehospital providers in CCTs 10 16. Dedicated dispatch of CCTs to severely injured patients, often covering large geographic areas by helicopter, has been shown to improve outcomes for trauma patients 21…”

Section: Discussionmentioning

confidence: 99%

Who does what in prehospital critical care? An analysis of competencies of paramedics, critical care paramedics and prehospital physicians

Vopelius-Feldt

Benger

2013

Emerg Med J

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Paramedics possess a considerable number of competencies which allow them to diagnose and treat a variety of conditions. CCPs and PHCC physicians possess a few additional critical care competencies which are potentially life-saving but are required infrequently and can carry significant risks. Concentration of training and clinical exposure for a small group of providers in critical care teams can help optimising benefits and reducing risks of PHCC.

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Section: Discussionmentioning

confidence: 99%

Who does what in prehospital critical care? An analysis of competencies of paramedics, critical care paramedics and prehospital physicians

Vopelius-Feldt

Benger

2013

Emerg Med J

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“…Several studies have documented that critical care teams composed of physicians and trained nurses achieve better outcomes for patients with severe TBI. 1,7,61,62,115 Even though critical care response teams incur longer median prehospital times than typical response teams (113 vs 45 minutes, respectively; p < 0.001), these increases were not an independent predictor of outcome. 61 Urgent transport following stabilization is, however, a priority for patients with mass lesions and impending cerebral herniation.…”

Section: 63mentioning

confidence: 93%

“…1,7,61,62,115 Even though critical care response teams incur longer median prehospital times than typical response teams (113 vs 45 minutes, respectively; p < 0.001), these increases were not an independent predictor of outcome. 61 Urgent transport following stabilization is, however, a priority for patients with mass lesions and impending cerebral herniation. For acute subdural hematomas, the mortality rate increases to 90% if surgical evacuation is delayed 4 hours or more after injury, as compared with a mortality rate of 30% if evacuation occurs sooner.…”

Section: 63mentioning

confidence: 93%

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Prehospital management of traumatic brain injury

Stiver¹,

Manley²

2008

FOC

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The aim of this study was to review the current protocols of prehospital practice and their impact on outcome in the management of traumatic brain injury. A literature review of the National Library of Medicine encompassing the years 1980 to May 2008 was performed. The primary impact of a head injury sets in motion a cascade of secondary events that can worsen neurological injury and outcome. The goals of care during prehospital triage, stabilization, and transport are to recognize life-threatening raised intracranial pressure and to circumvent cerebral herniation. In that process, prevention of secondary injury and secondary insults is a major determinant of both short- and longterm outcome. Management of brain oxygenation, blood pressure, cerebral perfusion pressure, and raised intracranial pressure in the prehospital setting are discussed. Patient outcomes are dependent upon an organized trauma response system. Dispatch and transport timing, field stabilization, modes of transport, and destination levels of care are addressed. In addition, special considerations for mass casualty and disaster planning are outlined and recommendations are made regarding early response efforts and the ethical impact of aggressive prehospital resuscitation. The most sophisticated of emergency, operative, or intensive care units cannot reverse damage that has been set in motion by suboptimal protocols of triage and resuscitation, either at the injury scene or en route to the hospital. The quality of prehospital care is a major determinant of long-term outcome for patients with traumatic brain injury.

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“…Pre-hospital tracheal intubation of severely injured patients has been shown to be potentially harmful, particularly if delivered without appropriate drugs, monitoring, equipment, training and clinical governance [28][29][30][31]. However, a number of well-designed studies have shown that there can be a functional and survival benefit associated with PHEA [3,5,6,[32][33][34][35][36][37][38]. Recognising that many patients should not have this intervention withheld, the Association of Anaesthetists of Great Britain and Ireland (AAGBI), in partnership with a number of national organisations, published guidance on the standards required for the safe provision of PHEA.…”

Section: Pre-hospital Emergency Anaesthesiamentioning

confidence: 99%

Anaesthesia and pre‐hospital emergency medicine

Steel

Klein

2012

Anaesthesia

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SummaryMajor trauma is a leading cause of death and disability in the UK, particularly in the young. Pre‐hospital emergency medicine (PHEM) involves provision of immediate medical care to critically ill and injured patients, across all age ranges, often in environments that may be remote and are not only physically challenging but also limited in terms of time and resources. PHEM is now a GMC‐recognised subspecialty of anaesthesia or emergency medicine and the first recognised training program in the UK commenced in August 2012. This article discusses subspeciality development in PHEM, the competency based framework for training in PHEM, and the provision of pre‐hospital emergency anaesthesia.

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Efficacy of prehospital critical care teams for severe blunt head injury in the Australian setting

Cited by 39 publications

References 16 publications

Who does what in prehospital critical care? An analysis of competencies of paramedics, critical care paramedics and prehospital physicians

Who does what in prehospital critical care? An analysis of competencies of paramedics, critical care paramedics and prehospital physicians

Prehospital management of traumatic brain injury

Anaesthesia and pre‐hospital emergency medicine

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