Prehospital intervention for trama: helpful or harmful? The European point of view

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Abstract
Management of trauma patients in the prehospital settings remains a controversial area. The “scope and run” and the “stabilization on scene” theories are the expression of completely different conceptions of the adapted response to life-threatening situations, serving different population of trauma patients. The major controversy over prehospital care between the US and the European systems involves the policy of prehospital volume loading. Although volume loading may be debated or delayed in patients with penetrating torso trauma, this is not the case in multiple-injured victims with severe head trauma. management of respiratory distress on site is less controversial. Efficient airway control and early mechanical ventilation have been clearly demonstrated to improve patient condition. Prehospital chest tube thoracostomy is safe when performed by a specialized team with extensive in-hospital experience. This aggressive prehospital intervention may be lifesaving in the case of tension pneumothorax. Time spent at the accident site is a frequently discussed point, but the time on scene must be compared with time conducting advanced lifesaving procedures in hospital before definitive treatment. The “scoop of run” strategy may, in addition, have a paradoxically negative outcome on the time elapsed before definitive care begins when the emergency department of the nearest hospital is overcrowded or the nearest hospital is not the most appropriate for the management of the case. Similarly, in cases involving mass casualties, rapid evacuation may take nearby hospitals by surprise and rapidly overwhelm their facilities. Use of physicians on scene providing advanced life support and controlling hospital admissions may avoid these problems. The ability to provide analgesia and anesthesia is another advantage for services involving physicians on scene. Controversy about the two systems has underscored the important fact that trauma patients are not a homogeneous group. Prehospital management must be adapted to the mechanism of trauma and the type of injuries suspected. Several major questions remain to be answered, suggesting that how to provide the best prehospital care will continue to be a lively debate.

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