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2.
Anaesthesia ; 74(9): 1158-1164, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31069782

RESUMEN

Advanced airway management is a treatment priority in trauma care. It is likely that a proportion of patients who receive urgent airway management on arrival in the emergency department represent an unmet demand for airway intervention in the pre-hospital phase. This study aimed to investigate emergency airway practice in major trauma patients and establish any unmet demand in this patient group. A retrospective review of the Trauma Audit and Research Network database was performed to identify airway intervention(s) performed for patients admitted to major trauma centres in England from 01 April 2012 to 27 June 2016. In total, 11,010 patients had airway interventions: 4375 patients (43%) had their tracheas intubated in the pre-hospital setting compared with 5889 patients (57%) in the emergency department. Of the patients whose tracheas were intubated in the emergency department, this was done within 30 min of hospital arrival in 3264 patients (75%). Excluding tracheal intubation, 1593 patients had a pre-hospital airway intervention of which 881 (55%) subsequently had their trachea intubated in the emergency department; tracheal intubation was done within 30 min of arrival in the majority of these cases (805 patients (91%)). Over 70% of emergency department tracheal intubations in patients with traumatic injuries were performed within 30 min of hospital arrival; this suggests there may be an unmet demand in pre-hospital advanced airway management for trauma patients in England.


Asunto(s)
Servicios Médicos de Urgencia/estadística & datos numéricos , Intubación Intratraqueal/estadística & datos numéricos , Heridas y Traumatismos/terapia , Adulto , Bases de Datos Factuales/estadística & datos numéricos , Inglaterra , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos
5.
Acta Anaesthesiol Scand ; 62(4): 504-514, 2018 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-29315456

RESUMEN

BACKGROUND: The benefits of pre-hospital emergency anaesthesia (PHEA) are controversial. Patients who are hypovolaemic prior to induction of anaesthesia are at risk of severe cardiovascular instability post-induction. This study compared mortality for hypovolaemic trauma patients (without major neurological injury) undergoing PHEA with a patient cohort with similar physiology transported to hospital without PHEA. METHODS: A retrospective database review was performed to identify patients who were hypotensive on scene [systolic blood pressure (SBP) < 90 mmHg], and GCS 13-15. Patient records were reviewed independently by two pre-hospital clinicians to identify the likelihood of hypovolaemia. Primary outcome measure was mortality defined as death before hospital discharge. RESULTS: Two hundred and thirty-six patients were included; 101 patients underwent PHEA. Fifteen PHEA patients died (14.9%) compared with six non-PHEA patients (4.4%), P = 0.01; unadjusted OR for death was 3.73 (1.30-12.21; P = 0.01). This association remained after adjustment for age, injury mechanism, heart rate and hypovolaemia (adjusted odds ratio 3.07 (1.03-9.14) P = 0.04). Fifty-eight PHEA patients (57.4%) were hypovolaemic prior to induction of anaesthesia, 14 died (24%). Of 43 PHEA patients (42.6%) not meeting hypovolaemia criteria, one died (2%); unadjusted OR for mortality was 13.12 (1.84-578.21). After adjustment for age, injury mechanism and initial heart rate, the odds ratio for mortality remained significant at 9.99 (1.69-58.98); P = 0.01. CONCLUSION: Our results suggest an association between PHEA and in-hospital mortality in awake hypotensive trauma patients, which is strengthened when hypotension is due to hypovolaemia. If patients are hypovolaemic and awake on scene it might, where possible, be appropriate to delay induction of anaesthesia until hospital arrival.


Asunto(s)
Anestesia , Servicios Médicos de Urgencia , Hipotensión/complicaciones , Heridas y Traumatismos/complicaciones , Adulto , Hemodinámica , Mortalidad Hospitalaria , Humanos , Hipotensión/fisiopatología , Estudios Retrospectivos , Vigilia , Heridas y Traumatismos/fisiopatología
6.
Transfus Med ; 28(4): 277-283, 2018 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-29067785

RESUMEN

INTRODUCTION: The current management of severely injured patients includes damage control resuscitation strategies that minimise the use of crystalloids and emphasise earlier transfusion of red blood cells (RBC) to prevent coagulopathy. In 2012, London's air ambulance (LAA) became the first UK civilian pre-hospital service to routinely carry RBC to the trauma scene. OBJECTIVE: To investigate the effect of pre-hospital RBC transfusion (phRTx) on overall blood product consumption. METHODS: A retrospective trauma database study compares before implementation with after implementation of phRTx in exsanguinating trauma patients transported directly to one major trauma centre. Pre-hospital deaths were excluded. Univariate and multivariate Poisson regression analyses on data subject to multiple imputation were conducted. RESULTS: We included 137 and 128 patients in the before and after the implementation of phRTx groups, respectively. LAA transfused 304 RBC units (median 2, inter quartile range 1-3). We found a significant reduction in total RBC usage and reduced early use of platelets and fresh-frozen plasma (FFP) after the implementation of phRTx in both univariate (P < 0·001) and multivariate analyses (P < 0·001). No immediate adverse transfusion reactions were identified. CONCLUSION: Pre-hospital trauma transfusion practice is feasible and associated with overall reduced RBC, platelets and FFP consumption.


Asunto(s)
Trastornos de la Coagulación Sanguínea/terapia , Transfusión de Eritrocitos , Plasma , Transfusión de Plaquetas , Heridas y Traumatismos/terapia , Adulto , Trastornos de la Coagulación Sanguínea/sangre , Femenino , Humanos , Londres , Masculino , Estudios Retrospectivos , Centros Traumatológicos , Heridas y Traumatismos/sangre
9.
Crit Care ; 21(1): 31, 2017 Feb 14.
Artículo en Inglés | MEDLINE | ID: mdl-28196506

RESUMEN

BACKGROUND: Pre-hospital basic airway interventions can be ineffective at providing adequate oxygenation and ventilation in some severely ill or injured patients, and advanced airway interventions are then required. Controversy exists regarding the level of provider required to perform successful pre-hospital intubation. A previous meta-analysis reported pre-hospital intubation success rates of 0.849 for non-physicians versus 0.991 for physicians. The evidence base on the topic has expanded significantly in the last 10 years. This study systematically reviewed recent literature and presents comprehensive data on intubation success rates. METHODS: A systematic search of MEDLINE and EMBASE was performed using PRISMA methodology to identify articles on pre-hospital tracheal intubation published between 2006 and 2016. Overall success rates were estimated using random effects meta-analysis. The relationship between intubation success rate and provider type was assessed in weighted linear regression analysis. RESULTS: Of the 1838 identified studies, 38 met the study inclusion criteria. Intubation was performed by non-physicians in half of the studies and by physicians in the other half. The crude median (range) reported overall success rate was 0.969 (0.616-1.000). In random effects meta-analysis, the estimated overall intubation success rate was 0.953 (0.938-0.965). The crude median (range) reported intubation success rates for non-physicians were 0.917 (0.616-1.000) and, for physicians, were 0.988 (0.781-1.000) (p = 0.003). DISCUSSION: The reported overall success rate of pre-hospital intubation has improved, yet there is still a significant difference between non-physician and physician providers. The finding that less-experienced personnel perform less well is not unexpected, but since there is considerable evidence that poorly performed intubation carries a significant risk of morbidity and mortality careful consideration should be given to the training and experience required to deliver this intervention safely.


Asunto(s)
Servicios Médicos de Urgencia , Personal de Salud/normas , Intubación Intratraqueal/normas , Servicios Médicos de Urgencia/métodos , Servicios Médicos de Urgencia/normas , Humanos , Intubación Intratraqueal/métodos , Recursos Humanos
10.
Anaesthesia ; 72(3): 379-390, 2017 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-28045209

RESUMEN

Pre-hospital emergency anaesthesia with oral tracheal intubation is the technique of choice for trauma patients who cannot maintain their airway or achieve adequate ventilation. It should be carried out as soon as safely possible, and performed to the same standards as in-hospital emergency anaesthesia. It should only be conducted within organisations with comprehensive clinical governance arrangements. Techniques should be straightforward, reproducible, as simple as possible and supported by the use of checklists. Monitoring and equipment should meet in-hospital anaesthesia standards. Practitioners need to be competent in the provision of in-hospital emergency anaesthesia and have supervised pre-hospital experience before carrying out pre-hospital emergency anaesthesia. Training programmes allowing the safe delivery of pre-hospital emergency anaesthesia by non-physicians do not currently exist in the UK. Where pre-hospital emergency anaesthesia skills are not available, oxygenation and ventilation should be maintained with the use of second-generation supraglottic airways in patients without airway reflexes, or basic airway manoeuvres and basic airway adjuncts in patients with intact airway reflexes.


Asunto(s)
Anestesia/normas , Servicios Médicos de Urgencia/normas , Manejo de la Vía Aérea/normas , Anestesia/métodos , Anestesiología/educación , Anestesiología/instrumentación , Competencia Clínica , Sedación Consciente/métodos , Sedación Consciente/normas , Educación de Postgrado en Medicina/normas , Servicios Médicos de Urgencia/organización & administración , Humanos , Intubación Intratraqueal/métodos , Intubación Intratraqueal/normas , Irlanda , Monitoreo Fisiológico/métodos , Monitoreo Fisiológico/normas , Transporte de Pacientes/normas , Reino Unido , Heridas y Traumatismos/terapia
11.
Injury ; 47(2): 383-8, 2016 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-26432661

RESUMEN

BACKGROUND: Examination of missed injuries in our physician-led pre-hospital trauma service indicated that the significant injuries missed were often pelvic fractures. We therefore conducted a study whose aim was to evaluate the pre-hospital diagnostic accuracy of pelvic girdle injuries, and how this would be affected by implementing the pelvic injury treatment guidelines recently published by the Faculty of Pre-Hospital Care. STUDY DESIGN: All blunt trauma patients attended in a 5-month period were included in the study. The presence or absence of pelvic girdle injury on computed tomography (CT) or, if unavailable, pelvic X-ray was used as a primary outcome measure. A retrospective database and case note review was conducted to identify patients who had pelvic binder applied in the study period. For the purposes of the study, pelvic ring and acetabular fractures were grouped together as patients with suspected pelvic girdle injury that should be fitted with a pelvic binder in the pre-hospital setting. The sensitivity and specificity, relating to the presence of pelvic girdle injury in patients with pelvic binders, was calculated in order to determine pre-hospital diagnostic accuracy. RESULTS: 785 patients were attended during the study period. 170 met the study inclusion criteria. 26 (15.3%) sustained a pelvic girdle injury. 45 (26.5%) had a pelvic binder applied. There were eight missed fractures (31%), of which the majority (six) sustained less severe injuries that were managed non-operatively. Two patients required operative fixation. Radiological images and/or reports were available on 169 (99.4%) patients. As a test of the presence of pelvic fracture, pelvic binder application had a sensitivity of 0.69 (95% CI 0.50-0.85) and a specificity of 0.81 (95% CI 0.74-0.87). CONCLUSIONS: Even with a careful clinical assessment and a low threshold for binder application, this study highlights the problems of distracting injury when trying to diagnose and manage pelvic fractures. By implementing the pelvic treatment guidelines published by the Faculty of Pre-hospital Care, the missed injury rate could be reduced from 31% to 8%.


Asunto(s)
Tratamiento de Urgencia , Fracturas Óseas/diagnóstico , Huesos Pélvicos/diagnóstico por imagen , Examen Físico , Tomografía Computarizada por Rayos X , Heridas no Penetrantes/diagnóstico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Femenino , Fracturas Óseas/cirugía , Humanos , Puntaje de Gravedad del Traumatismo , Masculino , Persona de Mediana Edad , Huesos Pélvicos/lesiones , Guías de Práctica Clínica como Asunto , Pautas de la Práctica en Medicina , Estudios Retrospectivos , Sensibilidad y Especificidad , Reino Unido , Heridas no Penetrantes/cirugía , Adulto Joven
12.
Br J Anaesth ; 114(4): 657-62, 2015 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-25540067

RESUMEN

BACKGROUND: Treatment of airway compromise in trauma patients is a priority. Basic airway management is provided by all emergency personnel, but the requirement for on-scene advanced airway management is controversial. We attempted to establish the demand for on-scene advanced airway interventions. Trauma patients managed with standard UK paramedic airway interventions were assessed to determine whether airway compromise had been effectively treated or whether more advanced airway management was required. METHODS: A prospective observational study was conducted to identify trauma patients requiring prehospital advanced airway management attended by a doctor-paramedic team. The team assessed and documented airway compromise on arrival, interventions performed before and after their arrival, and their impact on airway compromise. RESULTS: Four hundred and seventy-two patients required advanced airway intervention and received 925 airway interventions by ground-based paramedics. Two hundred and sixty-nine patients (57%) still had airway compromise on arrival of the enhanced care team; no oxygen had been administered to 52 patients (11%). There were 45 attempted intubations by ground paramedics with a 64% success rate and 11% unrecognized oesophageal intubation rate. Doctor-paramedic teams delivering prehospital anaesthesia achieved definitive airway management for all patients. CONCLUSIONS: A significant proportion of severely injured trauma patients required advanced airway interventions to effectively treat airway compromise. Standard ambulance service interventions were only effective for a proportion of patients, but might not have always been applied appropriately. Complications of advanced airway management occurred in both provider groups, but failed intubation and unrecognized oesophageal intubation were a particular problem in the paramedic intubation group.


Asunto(s)
Manejo de la Vía Aérea , Servicios Médicos de Urgencia , Heridas y Traumatismos/terapia , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Técnicos Medios en Salud , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Intubación Intratraqueal , Masculino , Persona de Mediana Edad , Grupo de Atención al Paciente , Estudios Prospectivos
13.
Br J Anaesth ; 113(2): 211-9, 2014 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-25038153

RESUMEN

Advanced airway management is one of the most controversial areas of pre-hospital trauma care and is carried out by different providers using different techniques in different Emergency Medical Services systems. Pre-hospital anaesthesia is the standard of care for trauma patients arriving in the emergency department with airway compromise. A small proportion of severely injured patients who cannot be managed with basic airway management require pre-hospital anaesthesia to avoid death or hypoxic brain injury. The evidence base for advanced airway management is inconsistent, contradictory and rarely reports all key data. There is evidence that poorly performed advanced airway management is harmful and that less-experienced providers have higher intubation failure rates and complication rates. International guidelines carry many common messages about the system requirements for the practice of advanced airway management. Pre-hospital rapid sequence induction (RSI) should be practiced to the same standard as emergency department RSI. Many in-hospital standards such as monitoring, equipment, and provider competence can be achieved. Pre-hospital and emergency in-hospital RSI has been modified from standard RSI techniques to improve patient safety, physiological disturbance, and practicality. Examples include the use of opioids and long-acting neuromuscular blocking agents, ventilation before intubation, and the early release of cricoid pressure to improve laryngoscopic view. Pre-hospital RSI is indicated in a small proportion of trauma patients. Where pre-hospital anaesthesia cannot be carried out to a high standard by competent providers, excellent quality basic airway management should be the mainstay of management.


Asunto(s)
Anestesia , Servicios Médicos de Urgencia/métodos , Heridas y Traumatismos/terapia , Manejo de la Vía Aérea/instrumentación , Manejo de la Vía Aérea/métodos , Anestésicos/administración & dosificación , Cartílago Cricoides , Prestación de Atención de Salud , Guías como Asunto , Humanos
14.
Resuscitation ; 85(2): 189-95, 2014 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-24145041

RESUMEN

INTRODUCTION: Trauma accounts for 16-44% of childhood deaths. The number of severely injured children who require pre-hospital advanced airway intervention is thought to be small but there is little published data detailing the epidemiology of these interventions. This study was designed to evaluate the children who received pre-hospital intubation (with or without anaesthesia) in a high volume, physician-led, pre-hospital trauma service and the circumstances surrounding the intervention. METHODS: We conducted a 12 year retrospective database analysis of paediatric patients attended by a United Kingdom, physician-led, pre-hospital trauma service. All paediatric patients (<16 years of age) that were attended and received pre-hospital advanced airway intervention were included. The total number of pre-hospital intubations and the proportion that received a rapid sequence induction (RSI) were established. To illustrate the context of these interventions the ages, injury mechanisms and intervention success rates were recorded. RESULTS: Between 1 January 2000 and 31 October 2011 the service attended 1933 children. There were 315 (16.3%) pre-hospital intubations. Of those intubated, 81% received a rapid sequence induction and 19% were intubated without anaesthesia in the setting of near or actual cardiac arrest. Nearly three quarters of the patients were in the age range of 6-15 years with only 3 patients under the age of 1 year. The most common injury mechanisms that required intubation were Road Traffic Crashes (RTC) and 'falls from height'. These accounted for 79% of patients receiving intubation. Intubation success rate was 99.7% with a single failed intubation during the study period. CONCLUSION: Pre-hospital paediatric intubation is not infrequent in this high-volume trauma service. The majority of patients received a rapid sequence induction. The commonest injury mechanisms were RTCs and 'falls from height'. Pre-hospital paediatric intubation is associated with a high success rate in this physician-led service.


Asunto(s)
Anestesia/estadística & datos numéricos , Servicios Médicos de Urgencia/organización & administración , Intubación Intratraqueal/estadística & datos numéricos , Heridas y Traumatismos/terapia , Adolescente , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Estudios Retrospectivos , Reino Unido
15.
Anaesthesia ; 68 Suppl 1: 30-9, 2013 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-23210554

RESUMEN

The word 'trauma' describes the disease entity resulting from physical injury. Trauma is one of the leading causes of death worldwide and deaths due to injury look set to increase. As early as the 1970s, it became evident that centralisation of resources and expertise could reduce the mortality rate from serious injury and that organisation of trauma care delivery into formal systems could improve outcome further. Internationally, trauma systems have evolved in various forms, with widespread reports of mortality and functional outcome benefits when major trauma management is delivered in this way. The management of major trauma in England is currently undergoing significant change. The London Trauma System began operating in April 2010 and others throughout England became operational this year. Similar systems exist internationally and continue to be developed. Anaesthetists have been and continue to be involved with all levels of trauma care delivery, from the provision of pre-hospital trauma and retrieval teams, through to chronic pain management and rehabilitation of patients back into society. This review examines the international development of major trauma care delivery and the components of a modern trauma system.


Asunto(s)
Heridas y Traumatismos/terapia , Defensa Civil , Servicios Médicos de Urgencia/organización & administración , Humanos , Pediatría , Centros Traumatológicos , Reino Unido , Estados Unidos
16.
J R Army Med Corps ; 158(2): 123-7, 2012 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-22860503

RESUMEN

OBJECTIVES: To determine how Injury Severity Score (ISS) and mortality relate to height fallen, and to determine other predictors of mortality including intent and body region injured. METHODS: A pre-hospital retrospective, observational database study was conducted. Injured or deceased patients following a fall from height (FFH), aged 16 or over, attended to by London Helicopter Emergency Medical Services (HEMS), between Jan 2008 to July 2009 were included in the study. In addition to the database, HEMS mission 'run sheets' provided further information. RESULTS: 117 (91 males and 26 females) patients met the inclusion criteria. The mean age was 37 years (range 16 - 85). 34/117 (29%) died. The mean ISS was 28.6 (median 17) and the mean height fallen 9.9m (3rd floor). In the group that died the mean height was 16.7m (5th floor). Height fallen was found to be a significant predictor of mortality (p < 0.001), as were injuries to the chest and/or head (p < 0.05). In patients with head and chest injuries, a 50% mortality rate was estimated to occur at falls from 10.5m, compared to 22.4m in those without injuries to head or chest. Deliberate falls were more common amongst females than males (chi-squared test, p = 0.001), were associated with greater ISS (Mann Whitney test, p < 0.001) and were more likely to result in death (chi-squared test, p < 0.001). CONCLUSIONS: Height fallen correlates with ISS and is a significant predictor of death. Chest and/or head injuries significantly increased the likelihood of death following a FFH. This information may enhance triage criteria applied to tasking of emergency response vehicles, and strategies in injury prevention. Other potential predictors of mortality were not found to be significant.


Asunto(s)
Accidentes por Caídas/mortalidad , Traumatismos Craneocerebrales/mortalidad , Puntaje de Gravedad del Traumatismo , Traumatismos Torácicos/mortalidad , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Distribución de Chi-Cuadrado , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores Sexuales , Suicidio , Intento de Suicidio , Adulto Joven
17.
Emerg Med J ; 29(9): 767-8, 2012 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-22903423

RESUMEN

A case of severe facial injury is described. The pre-hospital management including pre-hospital anaesthesia and intubation and the importance of advanced anaesthetic skills in rare trauma cases is discussed. In addition the rare situation where large bone fragments are retrieved from the scene and potentially used in reconstruction is mentioned.


Asunto(s)
Ciclismo/lesiones , Servicios Médicos de Urgencia , Traumatismos Faciales/terapia , Intubación Intratraqueal , Traumatismo Múltiple/terapia , Accidentes de Tránsito , Adulto , Traumatismos Faciales/etiología , Traumatismos Faciales/patología , Humanos , Masculino , Traumatismo Múltiple/etiología , Traumatismo Múltiple/patología , Factores de Tiempo
18.
Acta Anaesthesiol Scand ; 53(4): 543-5, 2009 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-19226295

RESUMEN

OBJECTIVES: To describe the use of ketamine in children by a pre-hospital physician-based service. METHODS: A five and a half year retrospective database review of all patients aged <16 years who were attended by London's Helicopter Emergency Medical Service and given ketamine. RESULTS: One hundred and sixty-four children met the inclusion criteria. The median age was 10 years (range 0-15 years). One hundred and four (63%) had a Glasgow Coma Scale (GCS) of 15 and 153 (93%) had a GCS>8 before administration of ketamine. Patients received from 2 to 150 mg ketamine IV (mean=1.0 mg/kg) and 112 (68%) received concomitant midazolam (0.5-18 mg, mean=0.1 mg/kg). One hundred and forty-one (86%) received ketamine intravenously and 23 (14%) intramuscularly. Only 12 patients (7%) were trapped. The most common mechanisms of injury in those who received ketamine were road traffic collisions, burns and falls. CONCLUSION: The safe delivery of adequate analgesia and appropriate sedation is a priority in paediatric pre-hospital care. Ketamine was predominantly used in awake non-trapped patients with blunt trauma for procedural sedation and analgesia. Detailed database searches did not demonstrate loss of airway, oxygen desaturation or clinically significant emergence reactions after ketamine administration. This study failed to demonstrate any major side effects of the drug and reassured us that the safety profile of the drug in this environment is likely to be satisfactory. The use of ketamine in trapped children was rare.


Asunto(s)
Analgésicos/uso terapéutico , Ketamina/uso terapéutico , Heridas y Traumatismos/tratamiento farmacológico , Adolescente , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Estudios Retrospectivos
19.
Emerg Med J ; 26(1): 62-4, 2009 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-19104109

RESUMEN

The safe delivery of adequate analgesia and appropriate sedation is a priority in prehospital care. The use of ketamine is described for analgesia and sedation in 1030 trauma patients in a physician-led prehospital trauma service. Ketamine was mainly used in awake non-trapped patients with blunt trauma for procedural sedation and analgesia. Detailed database searches did not demonstrate loss of airway, oxygen desaturation or clinically significant emergence reactions after ketamine administration. Ketamine is relatively safe when used by physicians in prehospital trauma care.


Asunto(s)
Analgésicos/administración & dosificación , Servicios Médicos de Urgencia , Hipnóticos y Sedantes/administración & dosificación , Ketamina/administración & dosificación , Heridas y Traumatismos/terapia , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Ambulancias Aéreas , Sedación Consciente/métodos , Femenino , Humanos , Londres , Masculino , Persona de Mediana Edad , Adulto Joven
20.
Emerg Med J ; 25(2): 108-12, 2008 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-18212153

RESUMEN

The threat of chemical, biological, radiological and nuclear incidents is unlikely to decrease and preparations to deal with this type of incident are well established in most European emergency medical systems. In the UK medical care is not currently provided in the "Hot" or contaminated zone. This article discusses the background to the current threat and suggests that, where survivors are present in the "Hot Zone", medical care should be started there to minimise delay and maximise the chances of survival.


Asunto(s)
Planificación en Desastres/métodos , Servicios Médicos de Urgencia/organización & administración , Terrorismo/prevención & control , Antídotos/uso terapéutico , Bioterrorismo/prevención & control , Terrorismo Químico/prevención & control , Descontaminación/métodos , Servicios Médicos de Urgencia/métodos , Humanos , Modelos Organizacionales , Equipos de Seguridad , Liberación de Radiactividad Peligrosa/prevención & control , Triaje/organización & administración , Reino Unido , Heridas y Traumatismos/prevención & control
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