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Mobility & Transport - Road Safety

What type of treatment?

While the old method of 'scoop and run' without any treatment is no longer practiced in high-income countries in Europe, to 'stay and play' at the scene may also be detrimental for the prognosis of the patient [7]. A recent survey of pre-hospital literature found only 24 randomised controlled trials and concluded there was insufficient data to provide a strong evidence base for the effectiveness of many common pre-hospital interventions [6]. The World Organization [50] distinguishes between basic and advanced systems of pre-hospital care.

Basic Life Support (BLS): Consists of emergency medical care to restore or sustain vital functions (airway, respiration, circulation) without specialized medical equipment and to limit further damage in the period preceding the arrival of specialized, advanced emergency medical care.

Advanced Life Support (ALS): Medical care given by medical doctors and nurses trained in critical care medicine with the use of specialized technical equipment, infusion of fluids and drugs aimed to stabilize or restore vital functions. Advanced life support is an integral part of a system of emergency medical services that needs adequate medical supervision.

While advanced systems are impressive and undoubtedly benefit some patients, WHO states that there is little evidence that they are inherently superior to systems that offer basic pre-hospital care. They may also hinder the overall provision of pre-hospital care if they lead system planners to divert scarce resources from basic interventions that benefit large numbers of patients to interventions that benefit fewer patients. With few exceptions (such as early defibrillation for victims of cardiac arrest), most advanced interventions have not been scientifically proven to be effective because the necessary randomised trials have not been conducted. In contrast, improved outcomes have been documented after bystanders and health-care providers have been educated to provide the fundamental elements of trauma care [50].

Scientific knowledge about the efficacy of pre-hospital medical care techniques is, thus, still evolving. The optimal approach needs to be determined for different types of trauma patients and well-controlled studies need to be carried out to address this question further. It is clear, however, that only essential treatment should be given so there is no unnecessary waste of time. Measures to protect the victim from further injury, basic life support measures such as providing a free airway and techniques used to aid breathing are considered essential. Mouth to mouth resuscitation and mask bag valve ventilation and decompression are also essential techniques. Measure to reduce circulatory failure and manoeuvres started for immobilising possible fractures to prevent further damage are also considered to be essential treatments [7].