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We argue quite a bit about the utility of 'scoop and run' (nee 'throw and
go') and the use of intermediate airway management techniques (e.g.
combitube). It seems we are so interested in getting the patient from the
scene to the hospital we sometimes forget the basic 'ABC's'.
 
While I do not get all of my medical citings from the lay press and I have
not seen the original article, I think this report brings to light an
interesting point. In the field we sometimes forget that it is ok to take
a few minutes to place an advanced airway in an unstable patient. Insuring
adequate 'ABC's' may make the difference between life and death. Yes, IMH
endotracheal intubation and cricothyrotomy are the only true advanced
airways used in the field.
 
As an aside, if anyone on the list is familiar with this study, would you
comment on the number of pediatric patients involved and their outcomes?
It is one of the 'conventional wisdoms' in peds emergency medicine that
EMS services that intubate children have better outcomes then those that
do not.
 
OK, I've openned it.... [article follows]
 
Jeff Linzer MD MICP
Prehospital Care Coordinator
Division of Pediatric Emergency Medicine
Emory University School of Medicine
[log in to unmask]
 
---------- Forwarded message ----------
Date: Thu, 26 Jun 1997 13:23:06 -0400
Subject: Fwd(2): trauma
 
 
Prehospital Intubation Improves Survival After Severe Head Trauma
 
WESTPORT, Jun 26 (Reuters) - In patients with severe head injury from
blunt trauma, endotracheal intubation in the field
results in better survival.
 
In the June issue of Archives of Surgery, Dr. Robert J. Winchell and
colleagues at the University of California, San Diego,
report for the Trauma Research and Education Foundation of San Diego on
a retrospective study of 1,092 patients with blunt
trauma and head injury. All patients had a Glasgow Coma Score at the
scene of 8 or less or an Abbreviated Injury Score of 4
or greater, and all were transported to a trauma center by ground
ambulance.
 
Overall, patients who were intubated by paramedics in the field had a
mortality rate of 26% compared with a mortality rate of
36% for patients not intubated, Dr. Winchell writes. In a subgroup with
more severe head injury, the mortality rate was
reduced from 57% to 36% with prehospital intubation. For patients with
isolated severe head injury, the mortality rate in the
group intubated by paramedics was 23% compared with 50% for patients not
intubated in the field.
 
He and his co-authors conclude, "Broadening indications for intubation
by paramedical personnel has great potential to
improve outcome in patients with severe head injury."
 
Arch Surg 1997;132:592-597.
 
-Westport Newsroom 203 319 2700
 
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