Prehospital Damage Control Resuscitation for Shock and Massive Haemorrhage

#prehospital #Resuscitation #Haemorrhage #Shock

Anne Weaver presents a rapid-fire overview of prehospital damage control resuscitation for shock and massive haemorrhage. She tells you how it is currently done in London, where she works, and what the future in this space might look like.

Haemorrhage and trauma present a massive burden on health worldwide. 2 million patients bleed to death from trauma every year. In the NHS, 6 000 trauma patients per year are defined as having major or massive haemorrhage. 30% of these patients will die.

To address this challenge in London, Anne discusses the multifaceted approach to managing major trauma. A paramedic is always stationed in a control room and can dispatch the appropriate resuscitation team to the trauma scene by air. Arrival is usually within 15 minutes. The teams comprise a doctor and a paramedic. They carry a huge amount of gear.

The teams are well equipped and well trained with a wide skillset.
Different initiatives have been successfully trialled in London and disseminated internationally. Once such initiative is the Cod Red protocol, a pre-hospital alert system. This was introduced in London in 2008 and aims to ensure the right resources are prepared at the hospital, prior to the pre-hospital team arriving with the patient. Alongside improvement in processes and treatments, this initiative has seen mortality rates for exsanguinating patients drop from around 60% to 30%.

Similarly, the decision to carry packed red cells on board has seen pre-hospital mortality decrease from 34% to 18%. Although this data is not from randomised controlled trials, it shows the innovation of the London HEMS service.

Technology is also moving into the space of resuscitation for shock and massive haemorrhage. A device used to measure compensatory reserve index – developed in the US Army – is one example. Using pulse oximetry, this small, portable device assists clinicians in decision making in pre-hospital resuscitation.

Questions remain… ideally the capacity to carry whole blood will be a near future improvement. In the meantime, Anne hopes that pre-hospital care can continue to impact the effect of trauma, shock, and massive haemorrhage.

https://codachange.org/prehospital-damage-control-resuscitation-for-shock-massive-haemorrhage/

Видео Prehospital Damage Control Resuscitation for Shock and Massive Haemorrhage канала Coda Change