Pepe P E, Stewart R D, Copass M K
Ann Emerg Med. 1986 Dec;15(12):1484-90. doi: 10.1016/s0196-0644(86)80949-0.
The controversies that have surrounded the prehospital management of trauma stem not only from a lack of appropriate evaluation data, but also from a lack of medical accountability and "street-wise," academic physician involvement within emergency medical services (EMS) systems. As a result, the approach to EMS trauma care has often been over-generalized and debated in terms of simplistic, unidimensional concepts, such as "scoop and run" versus "field stabilization," without any regard for the type and anatomic location of injury involved, the efficiency and skill of rescuers, the proximity and actual capabilities of definitive care resources, and the logistics of the prehospital setting. The failure to understand and delineate these variables has led to conflicting studies and has confused the analysis of potential therapeutic modalities and management strategies. In view of this, a survey is provided of three major cities, each with intensive, academic physician involvement in their EMS systems, and the approach and rationale for their prehospital care strategies are summarized. In all three systems, patients generally are categorized according to three major injury types (penetrating, blunt, and thermal) and then further subcategorized with regard to anatomical involvement, specifically those involving potential (or known) internal truncal injuries versus those with isolated head trauma or isolated extremity injury. For all three, high-flow O2 delivery and aggressive, advanced airway management (by endotracheal intubation whenever feasible) are keystones of management. In cases of potential or known internal truncal injury, the priority is also expeditious transport to facilities with definitive surgical care with the establishment of IV access and rapid fluid infusions en route.(ABSTRACT TRUNCATED AT 250 WORDS)
围绕创伤院前管理的争议不仅源于缺乏适当的评估数据，还源于医疗责任缺失以及急诊医疗服务（EMS）系统中缺乏“经验丰富”的学术型医生的参与。因此，EMS创伤护理的方法常常被过度概括，并依据诸如“ scoop and run”（快速转运）与“现场稳定”等简单、一维的概念进行辩论，而全然不顾所涉及损伤的类型和解剖位置、救援人员的效率和技能、确定性治疗资源的距离和实际能力以及院前环境的后勤保障。未能理解和界定这些变量导致了相互矛盾的研究，并使对潜在治疗方式和管理策略的分析变得混乱。鉴于此，本文对三个主要城市进行了调查，每个城市的EMS系统都有学术型医生深度参与，并总结了其院前护理策略的方法和基本原理。在所有这三个系统中，患者通常根据三种主要损伤类型（穿透伤、钝挫伤和热烧伤）进行分类，然后再根据解剖受累情况进一步细分，特别是那些涉及潜在（或已知）躯干内部损伤的患者与那些有孤立性头部创伤或孤立性肢体损伤的患者。对于所有这三个系统，高流量氧气输送和积极、先进的气道管理（只要可行就进行气管插管）是管理的关键要素。在存在潜在或已知躯干内部损伤的情况下，优先事项还包括迅速转运至具备确定性手术治疗的医疗机构，并在途中建立静脉通路和快速输液。（摘要截选至250字）
