Martin T E
4626 Aeromedical Evacuation Squadron, RAF Lyneham, Chippenham, UK.
Injury. 1993 Sep;24(8):514-6. doi: 10.1016/0020-1383(93)90025-2.
One of the most contentious issues surrounding the prehospital management of the injured is the decision to stabilize on site or to rapidly evacuate the patient. Although there are vociferous proponents for both views, there appears to be little thought given to the rationalization of these decisions, and the subject has only merited lip-service in previous texts. Treatment choices and decisions in the prehospital environment are notoriously difficult to make. The doctor, unlike ambulance paramedics, does not necessarily work to didactic protocols and, if suitably trained, is at liberty to commence advanced resuscitation procedures at the roadside. However, these may be time consuming and, to be of greatest benefit to the patient, a fine balance between resuscitation and evacuation must be drawn. This paper aims to discuss some of the key issues which need to be considered in the prehospital scenario, such as treatment triage, evacuation priorities, mode of transportation and hospital destination. The end result must be to eliminate the medical 'bottleneck' and to afford early and appropriate definitive care to those in most need.
围绕受伤患者院前处理最具争议性的问题之一是决定在现场进行稳定处理还是迅速转移患者。尽管两种观点都有强烈的支持者，但对于这些决策的合理性似乎很少有人思考，并且在以往的文献中这个问题也只是口头上被提及。院前环境中的治疗选择和决策 notoriously 难以做出。与救护车护理人员不同，医生不一定按照教条式的规程工作，并且如果经过适当培训，有权在路边开始高级复苏程序。然而，这些程序可能耗时，并且为了给患者带来最大益处，必须在复苏和转移之间找到一个良好的平衡。本文旨在讨论院前场景中需要考虑的一些关键问题，例如治疗分类、转移优先级、运输方式和医院目的地。最终结果必须是消除医疗“瓶颈”，并为最需要的人提供早期且适当的确定性治疗。
