ABC of major trauma. Transport of injured patients.
Authors: A Wilson, P Driscoll
Journal: BMJ (1990)

_ 0Victims of trauma begin dying immediately after their injuries have occurred.Prehospital care must provide early and expert resuscitation and -iF ^_|_ then transportation to the most appropriate hospital for the patient's needs.This care begins with first aid administered by bystanders and ends with the fully coordinated response of the hospital's trauma team.The criteria in the box are rarely met, and so the medical immediate care responder will have to make do with the facilities available in the locality.Remember that accident sites are dangerous.Safety to self comes first.Ensure that you are Requirements for provision of effective prehospital care immunised against tetanus and hepatitis.Wear * Public education in first aid and resuscitation appropriate clothing with reflective bands and designation labels, a helmet, and protective * An immediate communication system linking those at the accident site fear.Watch f jedmetal edge with ambulance controlfootwear.Watch for jagged metal edges, petrol . .~~~~~~~~~~~~~~~~and chemical spillages, and drivers who decide to * An instant computerised printout at ambulance control of the site from g nd the ac ent by driving o tehad which the call has been made and the map reference get round the accident by driving on the hard * Computerised identification of the nearest ambulance vehicles with shoulder.The patient should be moved instantly grading of their medical expertise.(These vehicles require a computer only if there is no chance of survival otherwise.printout of the accident location before being given full medical details)If you are not skilled in immediate care do not * An intelligent sequence of questions and answers between the controller get in the way of those who are.Doctors and the person reporting the accident inevitably have skills beyond those of the general * Immediately available medical advice to the controller public and should use them wisely and not panic. * Excellent lines of communication with emergency vehicles and immediateIt is a widely held belief that mortality in both care staff the first and second half hours after injury * Adequate numbers of emergency vehicles with properly trained increases by a factor of three if medical paramedics on board intervention is delayed.It is essential that delays * Uniform back up from doctors who can give immediate care are minimised and skilled medical intervention * Sensible triage with direct communication with the selected hospital occurs as soon after injury as possible.Expert * Medical helicopter transport from distant or inaccessible sites to a network resuscitation must be given continuously during of hospitals and trauma units transport from the scene of the accident to the receiving hospital.Movement should not interrupt this process. Resuscitation and immediate assessment A rigid collar isThere is no difference in principle between resuscitation in the accident used to protect the and emergency department and that at the accident site, but greater Dcervical spine of an impediments to a successful outcome face the first responder.Nevertheless accident victim, he or she must keep a level head and work out the most efficient method of achieving the same end points as are achieved in the ordered surroundings of the hospital resuscitation room. AirwayIn assessing and maintaining the airway take into account the patient's level of consciousness and position, vomiting, facial fractures, entrapment, and so on.If the patient is unable to maintain an airway then secure it immediately, but remember that any injury above the clavicles indicates that a cervical spine injury may coexist.Protect the cervical spine, preferably with a rigid collar, simultaneously with airway assessment.