Major interventions in the field stabilization of trauma patients: what is possible?

Previous studies on prehospital care are mostly hampered by a large number of less-urgent missions and lack of utilization of the possibilities which blur the effect of an advanced medical service. The current analysis of the most aggressive trauma care on-scene concludes that largely all vital stabilization can be carried out prehospitally, except performing an X-ray (with its possible consequences) and an operation. The latter measure does, however, also represent the current limits of field stabilization: circulatory unstable patients with penetrating bleeding trauma or presumed internal haemorrhagia will require a minimal stabilization--concentrating on securing the airway--and then fast transport to the nearest hospital with capability to carry out an acute operation (the 'scoop and run' principle). Novel principles and pathophysiological understanding indicate that new principles of field stabilization may actually offer further support and thereby increase the chances of survival for these patients, provided the necessary new techniques acknowledge the need for speed. In this development, the principles in prehospital care often exceeds what is actually offered in the hospitals' emergency rooms. Since the majority of advanced prehospital methods depends on comparatively safe anaesthesia and analgesia techniques, the particular responsibility for anaesthetists in this field is stressed.