Blackwell T H
Department of Emergency Medicine, Carolinas Medical Center, Charlotte, North Carolina.
Emerg Med Clin North Am. 1993 Feb;11(1):1-14.
To improve patient outcome and reduce time at the scene, treatment protocols for specific injuries and rapid transport should be established with individual systems. These standards should be based on such parameters as history, mechanism of injury, physiologic status of the patient on arrival, triage criteria, and predicted transport times. Ensuring airway patency and stability is a vital function that must be rapidly and carefully performed. Any patient at risk for neck or back trauma needs to be immobilized quickly using a rigid cervical collar with head immobilizer and long backboard. Initiation of IV fluids is acceptable if this skill can be accomplished within several minutes and does not significantly postpone transport. When prolonged or delayed transport times are encountered, aeromedical evacuation should be considered. Medical direction by a qualified physician with an interest in prehospital care and emergency medical services is an essential component in any successful system. The medical director should be strategically involved with protocol development, training and continuing education, and continuous quality improvement. Intensive supervised training in trauma management for EMTs and paramedics will help to reduce the amount of time spent at the scene of an accident. Emergency medical services have certainly come a long way over the past century. Indeed, more research is necessary in order to confirm, perfect, or dispute the many traditional theories that have been a part of prehospital technology. As the field of emergency medicine continues to develop and expand, so too will the specialty of prehospital medicine. Napoleon would be proud!
为改善患者治疗效果并减少现场停留时间，应与各独立系统制定针对特定损伤的治疗方案及快速转运措施。这些标准应基于病史、损伤机制、患者到达时的生理状态、分诊标准以及预计转运时间等参数。确保气道通畅和稳定是一项必须迅速且谨慎执行的关键功能。任何有颈部或背部创伤风险的患者都需要立即使用带有头部固定装置的硬质颈托和长背板进行固定。如果能在几分钟内完成静脉输液操作且不会显著延迟转运，那么进行静脉输液是可行的。当遇到长时间或延迟的转运情况时，应考虑空中医疗后送。由对院前急救和紧急医疗服务感兴趣的合格医生进行医疗指导是任何成功系统的重要组成部分。医疗主任应积极参与方案制定、培训与继续教育以及持续质量改进。对急救医疗技术员（EMT）和护理人员进行创伤管理的强化监督培训将有助于减少在事故现场花费的时间。在过去的一个世纪里，紧急医疗服务无疑取得了长足的进步。事实上，有必要进行更多研究以证实、完善或质疑许多作为院前技术一部分的传统理论。随着急诊医学领域不断发展和扩大，院前医学专业也将如此。拿破仑会感到骄傲的！
