Chapter 7: Prehospital Care

INTRODUCTION

Critically injured patients must receive high-quality care from the earliest post-injury moment to have the best chance of survival. Most trauma victims first receive health care from the emergency medical services (EMS) system, which is responsible for rendering aid and transporting the trauma patient to an appropriate facility.

The practice of medicine in the prehospital setting presents numerous challenges not encountered in the hospital. Hazardous materials along with environmental and climatic conditions may pose dangers to rescuers as well as to patients. If the patient is entrapped in a mangled vehicle or a collapsed building, there must be meticulous coordination of medical and rescue teams. Providers of prehospital care are expected to deliver high-quality medical care in situations that are austere and unforgiving and, often, for prolonged periods.

The role of the EMS system is far more complex than simply transporting the trauma victim to a medical facility. In most EMS systems in the United States, specially trained health care professionals are responsible for the initial assessment and management of the injured patient. Experience from the last several decades has shown that these paraprofessionals can safely perform many of the interventions that were previously performed only by physicians or nurses in the emergency department.

While many of these procedures have proven beneficial for victims of cardiac emergencies, critically injured patients may need two items not usually available on an ambulance—blood and a surgeon. As EMS systems mature and additional prehospital care research is conducted, the question is no longer, “What can the Emergency Medical Technician (EMT) do for the trauma patient in the prehospital setting?” but rather, “What should the EMT do?”

HISTORICAL PERSPECTIVE

While the roots of prehospital trauma care can be traced back to military physicians, modern civilian prehospital trauma care began about four decades ago. J.D. “Deke” Farrington and Sam Banks instituted the first trauma course for ambulance personnel in 1960.¹ This course, initiated with the Chicago Committee on Trauma and the Chicago Fire Academy, marked the beginning of formal training in prehospital care of injured patients. Farrington is generally acknowledged as the father of modern EMS.²

In September, 1966, the National Academy of Sciences and National Research Council published the landmark monograph, Accidental Death and Disability: The Neglected Disease of Modern Society.³ This document argued that there were no standards for ambulances with respect to design, equipment, or training of personnel. As a direct result of this monograph, the Department of Transportation funded the development of the Emergency Medical Technician–Ambulance (EMT-A) curriculum, which was published in 1969. Continued public pressure resulted in the passage of the Emergency Medical Services (EMS) Systems Act of 1973 (PL 93-154). This act revolutionized EMS in this country and resulted in federal funding for the establishment of EMS systems.

In the late 1950s, Pantridge, an ...