Debate: Prehospital Doctors add little value in Trauma
Anthony Holley and Marietjie ‘MJ’ Slabbert debate the value of prehospital doctors in trauma. Anthony argues that doctors in the prehospital setting add little value. He does so with the upmost respect for prehospital doctors and having worked in this setting himself. He makes the point that across the globe, the employment of doctors in the prehospital setting is a rarity. Working in this environment is diverse and every situation encountered requires a different skillset. This presents a logistical challenge. Anthony continues to discuss the evidence, or lack thereof, in this space. He raises the point of competing interests from paramedics, flight nurses and doctors themselves. This leads to apples being compared to oranges most of the time. Anthony goes on to suggest all the advanced clinical interventions that are necessary in prehospital situations can be competently undertaken by paramedics. MJ argues for the negative. In doing so, she concedes that the evidence base for prehospital medicine is scarce. This is due to inherent biases, the difficulty of gathering data and the issues with methodology. However, MJ believes that care provided outside of the hospital should be of the same level as care received in hospital. This provides a seamless patient journey from the prehospital setting into the hospital and improving the chain of survival. Furthermore, MJ posits that prehospital doctors not only improve care of patients outside of the hospital, but care for those in the hospital and clinics too. Prehospital physicians add value wherever they practise. They bring leadership, knowledge, additional skills, and training as well as innovation and collaboration. Tune in as Anthony and MJ debate over the value of prehospital doctors in trauma. For more like this, head to our podcast page. #CodaPodcast
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Debate: Prehospital Doctors add little value in Trauma
- 1. Prehospital Doctors Add Little Value In Trauma Dr Anthony Holley Emergency Physician and Intensivist
- 7. Prehospital Doctors Add Little Value In Trauma
- 11. Themes….. This is my clinical realm
- 12. Call for Consensus on Methodology and Terminology to Improve Comparability in the Study of Preventable Prehospital Trauma Deaths: A Systematic Literature Review. Acad Emerg Med. Oliver et al. 2016 Apr;23(4):503-10
- 14. Aggressive control of external haemorrhage Airway - emergency anaesthesia Thoracostomies/Thoracotomy Warmed blood products Experience/“Clinical judgement” Critical Interventions
- 15. Event Frequency?
- 16. For anaesthesiologists, the Task Force commissioned by the Scandinavian Society of Anaesthesia and Intensive Care Medicine recommends endotracheal intubation. Other physicians, as well as paramedics and other EMS personnel, are recommended the lateral trauma recovery position as a basic intervention combined with assisted mask-ventilation in trauma patients.
- 17. Proficiency of obtaining Grade I view at laryngoscopy was similar for physicians (74.70%) and CCPs (77.36%).
- 18. After Dr Steve Rashford
- 19. With thanks from Dr Steve Rashford
- 22. The Hard Facts….. • n = 25647 • 701 (2.7%) “Life saving treatment” • 596 (2.3%) exceeded the competencies of EMT • 225 (0.9%) ultimately discharged home
- 23. 0.09%
- 29. Lets face it… (most) (current) prehostpial EBM is B.S. - Bias - Notoriously difficult - Methodologically flawed… *Bit Scanty…. Brilliantly subjective....
- 42. LEADERSHIP
- 43. KNOWLEDGE
- 45. DECISION MAKING
- 47. INNOVATION
- 48. COLLABORATION
- 49. VISION
- 51. Hospital teams
- 52. Research teams
- 53. Simulation teams