Davis P R, Rickards A C, Ollerton J E
Consultant Emergency Medicine, 16 Close Support Medical Regiment, Southern General Hospital, Glasgow G51 4TF.
J R Army Med Corps. 2007 Dec;153(4):269-73. doi: 10.1136/jramc-153-04-10.
To determine the optimal composition o f the pre-hospital medical response team (MERT) and the value of pre-hospital critical care interventions in a military setting, and specifically to determine both the benefit of including a doctor in the pre-hospital response team and the relevance of the time and distance to definitive care.
A comprehensive review of the literature incorporating a range of electronic search engines and hand searches of key journals.
There was no level 1 evidence on which to base conclusions. The 15 most relevant articles were analysed in detail. There was one randomized controlled trial (level 2 evidence) that supports the inclusion of a doctor on MERT. Several cohort studies were identified that analysed the benefits of specific critical care interventions in the pre-hospital setting.
A doctor with critical care skills deployed on the MERT is associated with improved survival in victims of major trauma. Specific critical care interventions including emergency endotracheal intubation and ventilation, and intercostal drainage are associated with improved survival and functional recovery in certain patients. These benefits appear to be more easily demonstrated for the rural and remote setting than for the urban setting.
确定军事环境中院前医疗应急小组（MERT）的最佳组成以及院前重症护理干预的价值，特别是确定在院前应急小组中纳入医生的益处以及与确定性治疗的时间和距离的相关性。
对文献进行全面综述，包括使用一系列电子搜索引擎以及对关键期刊进行手工检索。
没有一级证据可作为得出结论的依据。对15篇最相关的文章进行了详细分析。有一项随机对照试验（二级证据）支持在MERT中纳入医生。还确定了几项队列研究，分析了院前环境中特定重症护理干预的益处。
在MERT中部署具备重症护理技能的医生与重大创伤受害者生存率的提高相关。包括紧急气管插管和通气以及肋间引流在内的特定重症护理干预与某些患者的生存率提高和功能恢复相关。这些益处似乎在农村和偏远地区比在城市地区更容易得到证明。
