Introduction:
It is crucial to take quick action immediately after a significant injury (like a road traffic accident) or on the onset of a life-threatening illness or condition (like stroke, cardiac arrest, and respiratory failure). The emergency medical services, interventions, and decisions of the pre-hospital period affect the survival of the patients. Pre-hospital care in emergency medicine constitutes a spectrum of care - from cardiopulmonary resuscitation to specific medical treatment - before or during the patient’s transfer to the hospital.
Predominantly, emergency medical service personnel provide pre-hospital care in the United States of America. The roles of the paramedical staff, emergency care doctors, and experts during the first hour of the emergency are of paramount importance. In addition, the emergency team’s rescue competencies, logistics, and management of emergencies play a significant role in pre-hospital care that affect the outcome.
What Are Emergency Medical Services (EMS)?
Emergency medical services or EMS is the system providing emergency medical care in case of incidents like life-threatening injuries, illnesses, and conditions. Emergency medical service provides a coordinated response and patient care for every type of emergency and arranges the ride to the hospital (by road or air). Pre-hospital care in emergencies is their key responsibility and primary mission. EMS is a large, complex system, and each element of this integrated system performs a crucial role. The EMS providers respond to all hazards and emergencies and work with public safety personnel in fire services and law enforcement.
The components of the EMS include the following:
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Both private and public organizations and agencies.
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Communications networks.
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Transportation networks.
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Emergency trauma systems.
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Hospitals and trauma centers.
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Specialty care centers.
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Rehabilitation facilities.
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Highly trained professionals.
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Pre-hospital personnel.
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Trained staff and doctors (physicians, nurses, and therapists).
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Government officials and administrators.
What Is Prehospital Medical Care?
The specialist (expert doctor) or physician-delivered element of pre-hospital care constitutes pre-hospital emergency medicine. Pre-hospital emergency medicine requires the medical knowledge of various injuries and diseases and the ability to provide complex medical procedures in varied medical emergency incidents. The specialized interventions performed in the hospital are delivered earlier in pre-hospital care - before or during the transfer of the patient. This minimizes the progress of the life-threatening illness or injury and helps stabilize the patients till they receive definitive treatment at the hospital. The pre-hospital care phase is extremely time-dependent as simple procedures initiated on time can save lives.
What Factors Affect Pre-hospital Care?
Various factors can affect the pre-hospital care provided. These include:
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Emergency Personnel: The number of skilled personnel and their competencies to provide basic to advanced medical care.
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Patient’s Status: The severity of the injury or illness.
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Environment: The patients may require care in varied environments like battlefields or mountain rescues. It might be difficult to provide care in certain environments.
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Resources: Equipment and resources must be available for providing specialized medical treatment. They also must be well maintained. These include the availability and service of transport vehicles to the hospital.
How Is Time a Key Factor in Pre-hospital Care?
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Time is crucial when dealing with a patient in an emergency, especially if the person has sustained a major injury or is unconscious and not breathing. Some savage injuries or illnesses like head, heart, or brain trauma can cause death within seconds to minutes.
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Simple procedures like assisted breathing or oxygen supply etc., when done on time, can save lives and help us stabilize the patient before receiving elaborate medical procedures in the hospital.
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Likewise, procedures like resuscitation and early defibrillation of the heart help prolong the life of cardiac arrest patients. The first hour after the incident causing an emergency is called the golden hour. In order to increase survival, all emergency medical services must be initiated, and the patient must reach the hospital for definitive care within this hour.
What Are Pre-hospital Care Interventions?
Many medical interventions or procedures are done in the pre-hospital period by trained and skilled staff and doctors. These can be simple or advanced, depending on the severity of the illness or injury. Examples include management of breathing and airway, cardiopulmonary resuscitation, management of bleeding, drug-assisted pre-hospital intubation, and emergency medications. Primary assessment (on first contact) of the patient's condition is important. The following are assessed and managed at first contact during an emergency:
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Airway: The emergency personnel ensures that the airway is clear. Simple procedures such as airway or endotracheal tube insertion and oxygen administration are performed to keep the airway open.
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Breathing: The patient’s breathing is assessed, and issues in spontaneous breathing, the rate of breathing, and the signs of pathology are identified and addressed. The warning signs of serious illnesses are identified, and corrective measures are initiated, including immediate ventilator support if needed.
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Circulation: Any issue with blood circulation in the body is assessed, including the volume of blood, the blood output from the heart, and bleeding. The level of consciousness of the patient, the color of the skin, and pulse irregularities are indicators of circulatory issues, and these are addressed immediately.
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Bleeding: Low blood pressure, rapid heart rate, and pulse are major blood loss indicators. Active bleeding is one of the major causes of death, and immediate measures must be initiated to stop bleeding. Simple measures to control bleeding and fluid resuscitation can help save lives.
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Disabilities: The level of a patient’s consciousness is established by using a rapid neurologic evaluation (Glasgow coma scale - GCS). The presence of other disabilities is assessed, and measures are initiated to prevent their progress.
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Environment or Exposure: The signs of concern on or around the patient are identified and managed. For example, if the patient’s body temperature is below normal, warm blankets or warming devices are used to restore the normal temperature (as loss of body temperature can be lethal).
How Are Patients Taken to the Hospital in an Emergency?
The patients can be mobilized and transported to the hospital or trauma care by road or air ambulance (helicopter). Transport by air is quicker but not the safest option available. Also, the use of air ambulances requires helipads near hospitals. A complete assessment of the situation and the patient’s condition is necessary to decide the mode of transport. Air ambulance is avoided for patients who might require high-quality cardiopulmonary resuscitation. Usually, road ambulances are safer and quicker, considering the delay in organizing the air ambulance.
The means of transport have to be decided promptly based on the following criteria:
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Traumatic or medical emergency - the clinical situation.
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The severity of the illness or injury.
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The work-space.
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Access roads to the hospital and their quality.
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Need for any specific items or equipment.
Conclusion:
Pre-hospital care in emergency medicine plays a vital role in increasing survival in severely injured or ill patients. The emergency personnel quickly assess the patient and initiate prompt interventions and treatment. The patient’s airway, breathing, circulation, disabilities, and exposure are assessed, and immediate medical treatment is initiated by emergency medical services. Simple interventions (such as obtaining intravenous access, fluid resuscitation, and oxygen supply), medical procedures, and medications provided in pre-hospital care can help save lives.
