Traumatic cardiac arrest: scope of paramedic services

The challenge of the 1960s to ambulance care provision was the stimulus for the emergence of prehospital advanced life support (ALS) being provided by paramedic personnel. While services for cardiac disease have been accepted, paramedic activities for the trauma victim continue to be a concern for many trauma surgeons. The capability and success rate of treatment, and the time spent at the scene and during transport to the hospital have raised questions about the overall need for paramedic services. Our study period was from January 1, 1981, to December 31, 1982, and it covered 95 clinically dead trauma victims who were first seen and subsequently treated by paramedics working in a medically controlled emergency medical services system. Endotracheal intubation was successful in 81 of the patients (85%). Esophageal obturator airway use was viewed as unsuccessful intubation. Intravenous (IV) access utilizing 16-gauge angiocaths was placed successfully by a peripheral or jugular vein in 70 patients (74%). Thirty-three patients averaged 860 mL volume infusion (30 to 3,000 mL). Average scene time was 22 minutes. Scene time of patients with unsuccessful IV and endotracheal intubation was 14 minutes (P = .07). Fourteen patients (14.7%) were admitted to the operating room or intensive care unit. Only three of the study group (3.2%) survived.