Newark a un systéme de de Medic dans des 4X4 déservant un territoire concentré avec un excellent, excellent volume de trauma urbain et un programme compétant d'assurance de la Qualité.
IS THE USE OF PREHOSPITAL RAPID SEQUENCE INTUBATION JUSTIFIED IN AN URBAN TRAUMA CENTER? A.M. Mohr MD, R.F. Lavery MA, Z. Semenovskaya, L.J. Magnotti MD, D.H. Livingston MD*, Department of Surgery, UMDNJ-New Jersey Medical School, Newark, NJ 0710 Background: While the importance of prehospital airway control with endotracheal intubation (ETI) is essential to the management of acutely injured patients, the use of rapid sequence intubation (RSI) by ground paramedic units (ALS) remains controversial. In our trauma system, only sedative agents are used to facilitate ETI in the field. To establish future potential for RSI use, this study examines patient outcomes after field ETI attempts in an urban trauma center. Methods: Prospective data were collected on patients brought to a level I trauma center during 2000-2001 by ALS who required airway control in the field. Three groups were studied: successful ETI (S-ETI), failed ETI (F-ETI), or sedative-facilitated ETI (SED-ETI). Scene and transport times, ALS IV access, and outcomes were collected. Results: Of the 5423 trauma patients evaluated, 4371 (81%) arrived by ALS. 291 (6.7%) patients had a field ETI attempt. 114 patients, found in cardiac arrest, were excluded and 177 patients (4% of ALS transports) were reviewed (Table). Sedative agents were used in 16 (9%) patients, with successful ETI noted in 5 (31%). ALS IV access was obtained in 70% of patients and mean transport time was 10 min (8 to 12) across all groups. % or means (95% CI) S-ETI F-ETI SED-ETI PATIENTS (n) 100 61 16 SCENE TIME (min) 10.1 (8 to 12) 9.3 (8 to 11) 15.4 (13 to 18) MORTALITY (LOS>24hrs) 16% 11% 14% EXTUBATED IN ED (n) 14(14%) 2(3%) 2(13%) Conclusions: Prehospital airway management is a priority, yet advanced airway management is infrequently used, necessary in only 4% of trauma patients not found in arrest. Also, the need for ETI was overestimated in 10% of these patients. Given the 50% additional scene time required for SED-ETI and the universal need for IV access, ALS use of RSI in an urban trauma center with short scene and transport times is not justified. Alicia M. Mohr MD UMDNJ-University Hospital 150 Bergen Street M-232 Newark, NJ 07103 Phone: (973) 972-8870 Fax: (973) 972-7441 Email: [EMAIL PROTECTED] Je peut pas en dire autant de Philadelphie. Par contre c'est à Philadelphie que la police a/avait l'habitude de transporter dans le derrière de leur van,les traumas par balles/armes blanches, sans soins (moins que BLS) Charles Brault IS IMMEDIATE INTUBATION IN THE TRAUMA RESUSCITATION AREA A USEFUL QUALITY INDICATOR OF PREHOSPITAL CARE? M.S. Park, MD; G.P. Dabrowski, MD; Janet McMaster, RN; Marty Kathrins, BA; P.M. Reilly, MD*; C.W. Schwab, MD* Division of Traumatology and Surgical Critical Care, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania Purpose: This study examines the incidence and indications for immediate intubations (II) in the Trauma Resuscitation Area (TRA) as a possible quality indicator. We hypothesize that II in the TRA may represent a failure of prehospital care (PC). Methods: All patients (pts) undergoing II between 1/2002 and 9/2002 were identified for chart review. The review was conducted as part of the standard Trauma Center Performance Improvement (PI) process. Individual reviews were performed by trauma faculty and discussed in conference. Charts were abstracted for indication for intubation, admission diagnosis, transport time, vitals signs, time to intubation, and mortality. Results: Over this 9-month period, a total of 1440 pts arrived as trauma alerts; 262 pts (18.2%) required II. Overall mortality was 6%. Mode of Arrival Prehospital TRA %TRA Flight EMS 43 22 33.8% Ground EMS 31 130 80.7% Private Vehicle/Police 0 32 100% Unknown 0 3 100% TOTAL 74 188 71.8% On PI review, 22 of 152 pts (14%) transported by EMS and intubated in the TRA may have benefited from prehospital intubation. - All 22 received II within 5 minutes of arrival. -Eighteen pts (15 Ground, 3 Flight) had unsuccessful prehospital intubation attempts with a 78% mortality vs pts who had successful prehospital intubation with a mortality of 47% (p<0.04); - 5 had no documented prehospital attempts (100% mortality). Conclusions: Most patients admitted to the TRA who required II were appropriately managed prehospital; 14% required II and by our PI review, may have benefited if intubated sooner. The higher rate of mortality in those with unsuccessful or no intubation attempt in PC indicates a potential to improve outcome. Immediate intubation in the TRA appears to be an important marker of quality prehospital care. Myung S. Park, MD Division of Traumatology and Surgical Critical Care 2 Dulles, 3400 Spruce Street Philadelphia, PA 19104 Phone: (215) 662-7320 Fax: (215) 349-5917 Email: [EMAIL PROTECTED] __________________________________ Do you Yahoo!? Yahoo! SiteBuilder - Free, easy-to-use web site design software http://sitebuilder.yahoo.com --- SMU-L Vous connaissez quelqu'un desirant devenir membre de la liste du prehospitalier? Demandez-lui d'envoyer un courriel a l'adresse de la liste ([EMAIL PROTECTED]) avec, comme sujet, le mot abonnement et son nom dans le corps du message.
