by Joe Moore
There are those in our community that don't believe that our EMS team are educated and know what they are doing, and EMS people certainly don't know what they are talking about. There are those that would like to degrade our local EMS people for whatever reason. . If you consider comments like, "All they want to do is make money," "They don't know what they are doing," They don't have the education.." If you consider these comments true, then read some research provided below, and then look in any textbook on emergency care. As a demonstration, below are a few statements made in a few research related searches for the public to consider.
(From the Annals of Surgery)
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1357175/
â??The fundamental tenet of a trauma system is to get the right patient to the right hospital at the right time. This hinges on well-defined prehospital destination criteria, interfacility transfer protocols, and education of caregivers. Patients arriving at local community hospitals (LOCs) benefit from stabilization and transfer to trauma centers (TCs) for definitive care. However, in the absence of a formalized trauma system, patients may not reach the TC in a timely fashion and may not be appropriately treated or stabilized at LOCs prior to transfer.â?
â??Thus, trauma system planning efforts should focus on 1) prehospital destination protocols that allow direct transport to the TC; and 2) education of caregivers in LOCs to enhance intervention skill sets and expedite transfer to definitive care.â?
(From JEMS Magazine)
http://www.jems.com/articles/2008/08/golden-hour.html
â??â??60 Precious Minutesâ??
The â??Golden Hourâ? was first described by R Adams Cowley, MD, at the University of Maryland Medical Center in Baltimore.1 From his personal experiences and observations in post-World War II Europe, and then in Baltimore in the 1960s, Dr. Cowley recognized that the sooner trauma patients reached definitive careâ??particularly if they arrived within 60 minutes of being injuredâ??the better their chance of survival.â?
http://www.mayoclinic.org/medical-profe ... itive-care
â??In emergency medicine, time is life, and most emergency departments meet or exceed the time-to-treatment benchmarks for ST-segment elevation myocardial infarction and acute stroke. But much less attention is given to the rapid triage and transfer of trauma patients, for whom time is just as critical.â?
http://www.annemergmed.com/article/S019 ... 3/fulltext
â??Sometimes old dogmas help save lives, allowing people with diverse levels of knowledge to grasp a simple concept. The golden hour of trauma is a classic example of this, and, as imperfect as it is, the concept of timely care must survive; no need to reset your clocks.â?
(World Health Organization)
http://www.who.int/bulletin/volumes/91/5/12-112664/en/
â??The term acute care encompasses a range of clinical health-care functions, including emergency medicine, trauma care, pre-hospital emergency care, acute care surgery, critical care, urgent care and short-term inpatient stabilization.â?
(Australian Journal of Rural Health)
http://onlinelibrary.wiley.com/doi/10.1 ... 0/abstract
â??However, the duration for transfer of patients is suboptimal because of the lack of established pathways for urgent non-trauma transfer from rural centres..â?
(Missouri Department of Health and Senior Services)
http://health.mo.gov/living/healthcondi ... tcdsystem/
â??Minutes make a difference
Severe injury requires timely definitive care for the best outcomes for survival and recovery. Likewise, stroke and STEMI heart attack victims who receive treatment within specific time frames from the time their symptoms begin are more likely to recover and less likely to have permanent disabilities. Currently, only a small percentage of stroke patients and less than half of heart attack patients in Missouri get help within the recommended amount of time.â?
http://www.emsworld.com/article/1143406 ... mergencies
â??Chris Granger, MD, chair of the AHA Mission: Lifeline project, recommends that if you can get a prehospital patient from first medical contact to balloon (E2B) within 90 minutes.â?
â??a joint effort is required to streamline times from first medical contact to balloon.â?
http://www.emsworld.com/article/1143406 ... mergencies
â??Each year nearly 800,000 U.S. citizens experience stroke, and the vast majority do not receive medical attention in time for early fibrinolytics to be considered.â?
â??Time is brain when a patient is a potential candidate for fibronlytics; for every minute delay that occurs prior to tPA administration for ischemic stroke, up to two million neurons die.â?
(Position Paper of the National Association of EMS Physicians)
http://www.naemsp.org/Documents/Positio ... 0Goals.pdf
â??This stems from their need for specialized definitive care in a time-limited fashion. For example, patients with myocardial injury or patients experiencing critical trauma demand complex interventions by the health care system. Trauma patients require response intervals targeted toward delivering the patient to definitive trauma care to prevent mortality and morbidity from shock. Patients experiencing myocardial injury require rapid reperfusion. These interventions can be expedited by a timely EMS responseâ?
So, the next time you want to make a comment about why our EMS wants to use the most timely and efficient method of getting a patient to definitive care, perhaps you could quote some of these accepted experts' opinions.
A wise man once said, "You can tell the truthfulness of your friendship by what your friend says behind your back."
Time to Definitive Care
Moderator: Gillespie