Prehospital care

To improve patient outcome and reduce time at the scene, treatment protocols for specific injuries and rapid transport should be established with individual systems. These standards should be based on such parameters as history, mechanism of injury, physiologic status of the patient on arrival, triage criteria, and predicted transport times. Ensuring airway patency and stability is a vital function that must be rapidly and carefully performed. Any patient at risk for neck or back trauma needs to be immobilized quickly using a rigid cervical collar with head immobilizer and long backboard. Initiation of IV fluids is acceptable if this skill can be accomplished within several minutes and does not significantly postpone transport. When prolonged or delayed transport times are encountered, aeromedical evacuation should be considered. Medical direction by a qualified physician with an interest in prehospital care and emergency medical services is an essential component in any successful system. The medical director should be strategically involved with protocol development, training and continuing education, and continuous quality improvement. Intensive supervised training in trauma management for EMTs and paramedics will help to reduce the amount of time spent at the scene of an accident. Emergency medical services have certainly come a long way over the past century. Indeed, more research is necessary in order to confirm, perfect, or dispute the many traditional theories that have been a part of prehospital technology. As the field of emergency medicine continues to develop and expand, so too will the specialty of prehospital medicine. Napoleon would be proud!