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Controlling hemorrhage remains the cornerstone of trauma management. Non-compressible torso hemorrhage is a particular challenge. Some (including me) have advocated for a change to the status quo of how we address this.
A paper in @JTraumAcuteSurg explores this further.
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A paper in @JTraumAcuteSurg explores this further.
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Here's a link to the full paper: https://journals.lww.com/jtrauma/Abstract/2020/06000/Early_and_prehospital_trauma_deaths__Who_might.10.aspx
The authors argue that we need to focus on a differing approach incorporating advanced prehospital hemorrhage control and hemostatic resuscitation.
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The authors argue that we need to focus on a differing approach incorporating advanced prehospital hemorrhage control and hemostatic resuscitation.
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This makes sense.
Remember the @theNASEM report on #ZeroPreventableDeath-this report highlighted not only a need to adopt military lessons into civilian trauma practice, but that up to 20% of annual trauma deaths are potentially preventable, many in the prehospital setting
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Remember the @theNASEM report on #ZeroPreventableDeath-this report highlighted not only a need to adopt military lessons into civilian trauma practice, but that up to 20% of annual trauma deaths are potentially preventable, many in the prehospital setting
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Other registry reviews have shown a significant proportion of patients with NCTH who arrive to the trauma center having arrested in the field.
For example, in the most recent #AORTA registry publication, this group made up 60% of their cohort
https://www.journalacs.org/article/S1072-7515(18)30098-X/abstract
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For example, in the most recent #AORTA registry publication, this group made up 60% of their cohort
https://www.journalacs.org/article/S1072-7515(18)30098-X/abstract
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The Carroll paper reviewed 316 trauma deaths in a single county and identified whether these deaths were potentially preventable (based on anatomy/physiology) if basic (e.g. TQ use) or advanced (e.g. #REBOA/thoracotomy/junctional TQ) prehospital techniques were applied
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In their analysis, up to 12% of prehospital and early hospital trauma deaths may have been preventable with these earlier interventions
This is similar to other papers that have looked at this, such as this paper from Drake et al in @AnnalsofSurgery https://journals.lww.com/annalsofsurgery/Abstract/2020/02000/Establishing_a_Regional_Trauma.27.aspx
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This is similar to other papers that have looked at this, such as this paper from Drake et al in @AnnalsofSurgery https://journals.lww.com/annalsofsurgery/Abstract/2020/02000/Establishing_a_Regional_Trauma.27.aspx
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Hence it is critical that we address this issue and look seriously at solutions to attempt to minimize this potentially preventable mortality.
One option is to implement civilian prehospital advanced resuscitative care (ARC) per @CommitteeonTCCC
https://www.jsomonline.org/SharedScience/2018437Butler.pdf
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One option is to implement civilian prehospital advanced resuscitative care (ARC) per @CommitteeonTCCC
https://www.jsomonline.org/SharedScience/2018437Butler.pdf
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Adopting this military approach (of using whole blood and techniques such as #REBOA at the point of injury) into civilian practice has many challenges:
It needs training, skilled personnel, right patient selection, strong QA-mostly it requires challenging the #statusquo
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It needs training, skilled personnel, right patient selection, strong QA-mostly it requires challenging the #statusquo
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Others (the UK, Europe, & Australia and more) have already been addressing this by bringing prehospital physicians/teams to the point of critical illness and injury - you need only look at the work of teams like @LDNairamb @EMRSscotland @SydneyHEMS @samudeparis
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Carroll's paper showed (using geospatial data) that 22 of their potentially preventable deaths occurred w/i 20 minutes drive and all w/i a 10 minute flight from their L1TC.
Having similar teams to attend these incidents should thus be explored.
#pushtheenvelope
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Having similar teams to attend these incidents should thus be explored.
#pushtheenvelope
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"Can't do it in the US, we're different" is a common mantra from naysayers.
Yes-there are significant challenges in the US, but it doesn't change the facts laid out in the data - we need to be addressing this preventable death, and that requires us to push the envelope
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Yes-there are significant challenges in the US, but it doesn't change the facts laid out in the data - we need to be addressing this preventable death, and that requires us to push the envelope
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It requires dedicated training, needs analysis, collaboration b/w #EMS & hospitals, protocols, & a strong QA structure.
This could take the shape of physician-delivered field care (already happening in US eg @MD1Program @UCEmergencyEMS @PittEMSDocs @nmemsfellowship) or...
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This could take the shape of physician-delivered field care (already happening in US eg @MD1Program @UCEmergencyEMS @PittEMSDocs @nmemsfellowship) or...
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Empowering systems to improve and advance their own prehospital care systems and care delivery utilizing their existing staff (paramedics, critical care transport nurses/NPs/PAs, CRNAs) by training them in ARC, in particular the field administration of blood products
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If we are serious about improving outcomes from trauma, and reaching #ZeroPreventableDeaths - it behooves us as a trauma community to look at what is possible elsewhere and adopt those principles and practices responsibly within our own systems to help our communities.
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