The document discusses the controversial role of prehospital doctors in trauma care, arguing that they add limited value based on a systematic literature review. It highlights the need for improved methodology and terminology to address preventable prehospital trauma deaths and critiques existing evidence-based medicine in this field. The author emphasizes the importance of seamless patient care and acknowledges the significant contributions of prehospital doctors despite criticisms.

1. Prehospital Doctors Add Little
Value In Trauma
Dr Anthony Holley
Emergency Physician and Intensivist

2. Acknowledgements & Conflict

5. #MakePrehospitalCareGreatAgain

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%

27. Bare knuckle knock out
Prehospital doctors add little value in
trauma??

28. Conflict of interest

29. Lets face it…
(most) (current) prehostpial EBM is B.S.
- Bias
- Notoriously difficult
- Methodologically flawed…
*Bit Scanty…. Brilliantly subjective....

30. Reality is: We want
(our patients deserve)
Same level + standard of care as IN
hospital

31. Reality is: We want
(our patients deserve)
Seamless patient journey

32. The beginning (or the end) of the trauma chain of survival…

33. Prehospital doctors in the field

35. Prehospital doctor as Trauma Team leaders

36. Prehospital doctor(s) in the trauma bay

37. Prehospital
doctors in
OR
Gas-docs

38. Prehospital
doctors in
OR
Surgeons

39. Pre hospital
ICU doctors

40. Family physicians, Cardiologist,
neonatologist

41. Bridges not walls

42. LEADERSHIP

43. KNOWLEDGE

44. ADDITIONAL SKILLS AND
TRAINING

45. DECISION MAKING

46. ANTICIPATED CLINICAL
CAUSE

47. INNOVATION

48. COLLABORATION

49. VISION

50. Prehospital teams

51. Hospital teams

52. Research teams

53. Simulation teams

54. unpublished ‘truth’
EVERY DAY
ALL OVER THE GLOBE
PREHOSPITAL DOCTORS
ARE HELPING TO SAVE LIVES

55. Don’t take my word for it…

56. Legion of extraordinary gentlemen and
gentle-ladies

116. …we ARE many
...we CARE a lot

117. You dare say we add little….?
Really? REALLY? No, I say,
“a HELL of a LOT”doesn’t even
cover it

118. “Honourable intentions”
“Meaningful interventions”
Dr. John Hinds (1980- 2015)