A review of the literature was carried out to determine the importance of pre-hospital scene times and how it can be affected. In the UK, and certain centres in North America, mortality and morbidity in critically injured patients appears to be related to scene times. The majority of these patients only require basic life support at the scene. Consequently the possible benefits of more advanced procedure need to be compared with the transportation period, the time needed to mobilize a medical team and skill proficiency. Cardiovascular resuscitation procedures in particular require reappraisal. Though haemostasis is essential, there is little evidence to support the use of fluid resuscitation in nontrapped urban patients with a significant haemorrhage problem. In contrast patients who are not bleeding do appear to benefit from advanced life support procedures even though this increases scene time. There is therefore a need for pre-hospital paramedic workers to triage patients so that appropriate resuscitation can be carried out.
Anderson I, Black R, McA Ledingham I, Robertson C, Urquhart J.Early emergency care study: the potential benefits of advanced prehospital care. BMJ1987; 294: 228-231.
2.
Atherton G, Johnson J.Ability of paramedics to use the combitubeTM in prehospital cardiac arrest. Ann Emerg Med1993; 22: 1263-1268.
3.
Baskett P.The use of the laryngeal mask airway by nurses during cardiopulmonary resuscitation. Anaesthesia1994; 49: 3-7.
4.
Bickell W, Wail M, Pepe Pet al.A comparison of immediate versus delayed fluid resuscitation for hypotensive patients with penetrating torso injury. N Engl J Med1994; 331: 1105-1109.
5.
Bissell R, Eslinger D.Advanced life support literature review. The American Ambulance Association, National Study Centre for Trauma and EMS. University of Maryland at Baltimore, USA, July 1995.
6.
Campbell J, Gratton M, Salmone J, Watson W.Ambulance arrival to patient contact: the hidden component of prehospital response times. Ann Emerg Med1993; 22: 1254-1257.
7.
Capone A, Safar P, Stezoski W, Tisherman S, Peitzman A.Improved outcome with fluid restriction in treatment of uncontrolled hemorrhagic shock. J Am Coll Surg1995; 180: 49-56.
8.
Clevenger F, Yarbrough D, Reines H.Resuscitative thoracotomy: the effect of field time on outcome. J Trauma1988; 28: 441-445.
9.
Copass M, Oreskovich M, Bladergroen M, Carrico C.Pre-hospital cardiopulmonary resuscitation in critically injured patients. Am J Surg1984; 48: 20-26.
10.
Criswell J, Nolan J.Emergency airway management in patients with cervical spine injuries. Anaesthesia1994; 49: 90-93.
11.
Cwinn A, Pons P, Moore E, Marx J, Honigman B, Dinerman N.Pre-hospital advanced trauma life support for critical blunt trauma victims. Ann Emerg Med1987; 16: 399-403.
12.
Daley K, Thomas P.Trauma deaths in the south west Thames region. Injury1992; 23: 393-396.
13.
Davies P, Tighe S, Greenslade G, Evans G.Laryngeal mask airway and tracheal tube insertion by unskilled personnel. Lancet1990; 336: 97779-97779-97779.
14.
Faculty of Prehospital Care and JCALC Trauma Subcommittee. Joint position statement on spinal immobilisation and extrication. Pre-hospital Care Journal (in press).
15.
Feero S, Hedges J, Simmons E, Irwin L.Does out-of-hospital EMS time effect trauma survival?Am J Emerg Med1995; 13: 133-135.
16.
Fortner G, Oreskovich M, Copass M, Carrico C.The effect of prehospital trauma care on survival from a 50-meter fall. J Trauma1983; 23: 976-981.
17.
Gabram S, Jacobs L, Schwartz R, Stohler S.Airway intubation in injured patients at the scene of an accident. Conn Med1989; 53: 633-637.
18.
Gervin A, Fischer R.The importance of prompt transport in salvage of patients with penetrating heart wounds. J Trauma1982; 22: 443-447.
19.
Gold C.Prehospital advanced life support vs Scoop and Run in trauma management. Ann Emerg Med1987; 16: 797-801.
20.
Gwinnutt C.Alternatives to endotracheal intubation in airway management. J Br Assoc Immed Care1996; 19: 37-41.
Honigman B, Rohweder K, Moore E, Lowenstein S, Pons P.Prehospital advanced trauma life support for penetrating cardiac wounds. Ann Emerg Med1990; 19: 145-150.
Jacobs L, Sinclair A, Beiser A, D’Agostino R.Prehospital advanced life support: Benefits in trauma. J Trauma1984; 24: 81-83.
25.
Jacobson L, Gomez G, Sobieray R, Rodman G, Solotkin K, Misinski M.Surgical cricothyroidotomy in trauma patients: analysis of its use by paramedics in the field. J Trauma1996; 41: 15-20.
26.
John R, Hill S, Hughes T.Airway protection by the laryngeal mask. A barrier to dye placed in the pharynx. Anaesthesia1991; 46: 366-367.
27.
Johnson G, Guly H.The effect of pre-hospital administration of intravenous nalbuphine on on-scene times. J Accid Emerg Med1995; 12: 20-22.
28.
Jones S, Nesper T, Alcouloumre E.Prehospital intravenous line placement: A prospective study. Ann Emerg Med1989; 18: 244-246.
29.
Kaweski S, Sise M, Virgilio R.The effect of prehospital fluids on survival in trauma patients. J Trauma1990; 30: 1215-1219.
30.
Koehler J, Malafa S, Hillesland J, Baer L, Rogers R, Navitskas N.A multicenter validation of the prehospital index. Ann Emerg Med1987; 16: 380-385.
31.
Krausz M, Bar-Ziv M, Rabinovici R, Gross D.Scoop and run or stabilize haemorrhagic shock by normal saline or small volume hypertonic saline?J Trauma1992; 33: 6-10.
32.
Landau E, Gross D, Assalia A, Krausz M.Treatment of uncontrolled hemorrhagic shock by hypertonic saline and external counter pressure. Ann Emerg Med1989; 18: 1039-1043.
33.
Landau E, Gross D, Assalia A, Feign E, Krausz M.Hypertonic saline infusion in hemorrhagic shock treated by military antishock trousers (MAST) in wake sheep. Crit Care Med1993; 21: 1554-1561.
Limb D, MacGowan A, Fairfield J, Pigott T.Prehospital deaths in the Yorkshire Health Region. J Accid Emerg Med1996; 13: 248-250.
36.
Martin P, Cyna A, Hunter W, Henry J, Ramayya G.Training nursing staff in airway management for resuscitation: A clinical comparison of the facemask and laryngeal mask. Anaesthesia1993; 48: 33-37.
37.
Maio R, Burney R, Gregor M, Baranski M.A study of preventable trauma mortality in rural Michigan. J Trauma1996; 41: 83-90.
38.
Matsuoka T, Hildreth J, Wisner D.Uncontrolled hemorrhage from parenchymal injury: Is resuscitation helpful?J Trauma1996; 40: 915-922.
39.
McDermott F, Cordner S, Tremayne A.Evaluation of the medical management and preventability of death in 137 road traffic fatalities in Victoria, Australia: An overview. J Trauma1996; 40: 520-533.
40.
Messick J, Rutledge R, Meyer A.The association of advanced life support training and decreased per captia trauma death rates: An analysis of 12,417 trauma deaths. J Trauma1992; 33: 850-855.
41.
Miller J, Becker D.Secondary insults to the injured brain. JR Coll Surg Edin1986; 27: 292-298.
42.
Nicholl J.The role of the helicopter in pre-hospital care. Prehospital Immediate Care1997; 1: 82-90.
43.
Nicholl J, Hughes S, Dixon S, Yates D.The costs and benefits of paramedic skills in pre-hospital trauma care. Sheffield: Health Technology Assessment, 1998.
44.
Norwood S, Myers M, Butler T.The safety of emergency neuromuscular blockade and orotracheal intubation in the acutely injured trauma patient. J Am Coll Surg1994; 179: 646-652.
Pennant J, Walker M.Comparison of the endotracheal tube and laryngeal mask in airway management by paramedical personnel. Anaesth Analg1992; 74: 531-534.
47.
Pons P, Moore E, Cusick J, Brunko M, Antuna B, Owens L.Prehospital venous access in an urban paramedic system - a prospective on-scene analysis. J Trauma1988; 28: 1460-1463.
Powar M, Nguyen-Van-Tam J, Pearson J, Dove A.Hidden impact of paramedic interventions. J Accid Emerg Med1996; 13: 383-385.
50.
Rabinovici R, Krausz M, Feurstein G.Control of bleeding is essential for a successful treatment of hemorrhagic shock with 7.5 percent NaCl solution. Surg Gynecol Obstet1991; 173: 98-106.
51.
Rainer T, Houlihan K, Robertson C, Beard D, Henry J, Gordon M.An evaluation of paramedic activities in prehospital trauma care. J Accid Emerg Med1997; 14: 122-123.
52.
Regel G, Stalp M, Lehmann U, Seekamp A.Prehospital care, importance of early intervention on outcome. Anaesth Scand1997; 110: 71-76.
53.
Reinhart D, Simmons G.Comparison of placement of the laryngeal mask airway with endotracheal tube by paramedics and respiratory therapists. Ann Emerg Med1994; 24: 260-263.
54.
Reines H, Barlett R, Chudy N, Kiragin K, McKnews M.Is advanced life support appropriate for victims of motor vehicle accidents? The South Carolina Highway Trauma project. J Trauma1988; 28: 563-570.
55.
Rhee K, O’Malley R.Neuromuscular blockade-assisted oral intubation versus nasotracheal intubation in the prehospital care of injured patients. Ann Emerg Med1994; 23: 37-42.
56.
Samapalis J, Lavole A, Williams J, Mulder D, Kalina M.Impact of on-site care, pre-hospital time and level of inhospital care on survival in severely injured patients. J Trauma1993; 34: 252-261.
57.
Schmidt U, Frame S, Nerlich M, Rowe D, Enderson B, Maull K, Tscherne H.On scene helicopter transport of patients with multiple injuries - comparison of a German and an American system. J Trauma1992; 33: 548-553.
58.
Smith J, Bodai B, Hill A, Frey C.Prehospital stabilisation of critically injured patients: a failed concept. J Trauma1985; 25: 65-70.
59.
Spaite D, Joseph M.Prehospital cricothyroidotomy: An investigation of indications, technique, complications and patient outcome. Ann Emerg Med1990; 19: 279-285.
60.
Spaite D, Tse D, Valenzuela T, Criss E, Meislin H, Mahoney M, Ross J.The impact of injury severity and prehospital procedures on scene time in victims of major trauma. Ann Emerg Med1991; 20: 1299-1351.
61.
Spaite D, Valenzuela T, Criss E, Meislin H, Hinsberg P.A prospective in-field comparison of intravenous line placement by urban and nonurban emergency medical services personnel. Ann Emerg Med1994; 24: 209-214.
62.
Stern S, Dronnen S, Birrer P, Wang X.Effect of blood pressure on hemorrhage volume and survival in a near-fatal hemorrhage model incorporating a vascular injury. Ann Emerg Med1993; 22: 155-163.
63.
Stewart R, Paris P, Winter P, Petton G, Cannon G.Field endotracheal intubation by paramedical personnel: success rates and complications. Chest1984; 85: 341-345.
64.
Trunkey D.Is ALS necessary for pre-hospital trauma care?J Trauma1984; 24: 86-87.
65.
Verghese C, Smith T, Young E.Prospective survey of the use of the laryngeal mask airway in 2359 patients. Anaesthesia1993; 48: 58-60.
66.
Wade C, Hannon J.Resuscitation of conscious pigs following haemorrhage. Comparative efficacy of small volume resuscitation with normal saline, 7.5% NaCl, 6% Dextran - 70 and 7.5% NaCl in 6% Dextran - 70. Circ Shock1989; 29: 193-204.
67.
Wade C, Grady J, Kramer G.Efficacy of hypertonic saline dextran (HSD) in patients with traumatic hypotension: meta-analysis of individual patient data. Acta Anaesth Scand1997; 110: 77-79.
68.
Wyatt J, Beard D, Gray A, Busuttil A, Robertson C.The time of death after trauma. BMJ1995; 310: 1502-1502-1502.
69.
Wyatt J, Beard D, Gray A, Busuttil A, Beattie T, Robertson C.Timing of paediatric deaths after trauma. BMJ1997; 314: 868-868-868.
