Abstract
Pre hospital management of critically injured patients is challenging but the application of a framework for key decisions can aid management in stressful austere environments. The field is continually evolving and evidence emerging for the use of novel therapies such as Resuscitative Balloon Occlusion of the Aorta (REBOA) for uncompressible lower body haemorrhage. Patients with traumatic cardiac arrest pose a particular challenge but the application of a management framework that includes that early use of focussed echocardiography and aggressive volume resuscitation can produce unexpected survivors from what had previously been considered a universally fatal condition. Resuscitative thoracotomy has been widely adopted by military and civilian healthcare providers and has a role in selected patients. The nature of the pre-hospital retrieval service is of importance and there is evidence that specialist physician delivered care improves outcomes. One such service, the UK military Medical Emergency Response Team (MERT), is described in detail.
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Calderbank P, Woolley T, Mercer S, Schrager J, Kazel M, Bree S, et al. Doctor on board? What is the optimal skill-mix in military pre-hospital care? Emerg Med J. 2011;28(10):882–3.
Barnard EB, Moy RJ, Kehoe AD, Bebarta VS, Smith JE. Rapid sequence induction of anaesthesia via the intraosseous route: a prospective observational study. Emerg Med J. 2015;32(6):449–52.
Kirkman E, Watts S. Haemodynamic changes in trauma. Br J Anaesth. 2014;113(2):266–75.
Watts S, Nordmann G, Brohi K, Midwinter M, Woolley T, Gwyther R, et al. Evaluation of Prehospital Blood Products to Attenuate Acute Coagulopathy of Trauma in a Model of Severe Injury and Shock in Anesthetized Pigs. Shock. 2015;44 Suppl 1:138–48.
Doran CM, Doran CA, Woolley T, Carter A, Male K, Midwinter MJ, et al. Targeted resuscitation improves coagulation and outcome. J Trauma Acute Care Surg. 2012;72(4):835–43.
Morrison JJ, Ross JD, Poon H, Midwinter MJ, Jansen JO. Intra-operative correction of acidosis, coagulopathy and hypothermia in combat casualties with severe haemorrhagic shock. Anaesthesia. 2013;68(8):846–50.
Weaver AE, Hunter-Dunn C, Lyon RM, Lockey D, Krogh CL. The effectiveness of a ‘Code Red’ transfusion request policy initiated by pre-hospital physicians. Injury. 2016;47(1):3–6.
Morrison JJ, Ross JD, Houston R, Watson JD, Sokol KK, Rasmussen TE. Use of resuscitative endovascular balloon occlusion of the aorta in a highly lethal model of noncompressible torso hemorrhage. Shock. 2014;41(2):130–7.
Saito N, Matsumoto H, Yagi T, Hara Y, Hayashida K, Motomura T, et al. Evaluation of the safety and feasibility of resuscitative endovascular balloon occlusion of the aorta. J Trauma Acute Care Surg. 2015;78(5):897–903.
Norii T, Crandall C, Terasaka Y. Survival of severe blunt trauma patients treated with resuscitative endovascular balloon occlusion of the aorta compared with propensity score-adjusted untreated patients. J Trauma Acute Care Surg. 2015;78(4):721–8.
Brenner ML, Moore LJ, DuBose JJ, Tyson GH, McNutt MK, Albarado RP, et al. A clinical series of resuscitative endovascular balloon occlusion of the aorta for hemorrhage control and resuscitation. J Trauma Acute Care Surg. 2013;75(3):506–11.
Chaudery M, Clark J, Morrison JJ, Wilson MH, Bew D, Darzi A. Can contrast-enhanced ultrasonography improve Zone III REBOA placement for prehospital care? J Trauma Acute Care Surg. 2016;80(1):89–94.
Morrison JJ, Ross JD, Rasmussen TE, Midwinter MJ, Jansen JO. Resuscitative endovascular balloon occlusion of the aorta: a gap analysis of severely injured UK combat casualties. Shock. 2014;41(5):388–93.
Barnard EB, Morrison JJ, Madureira RM, Lendrum R, Fragoso-Iniguez M, Edwards A, et al. Resuscitative endovascular balloon occlusion of the aorta (REBOA): a population based gap analysis of trauma patients in England and Wales. Emerg Med J. 2015;32(12):926–32.
Morrison JJ, Lendrum RA, Jansen JO. Resuscitative endovascular balloon occlusion of the aorta (REBOA): a bridge to definitive haemorrhage control for trauma patients in Scotland? Surgeon. 2014;12(3):119–20.
Markov NP, Percival TJ, Morrison JJ, Ross JD, Scott DJ, Spencer JR, et al. Physiologic tolerance of descending thoracic aortic balloon occlusion in a swine model of hemorrhagic shock. Surgery. 2013;153(6):848–56.
Morrison JJ, Rasmussen TE. Noncompressible torso hemorrhage: a review with contemporary definitions and management strategies. Surg Clin North Am. 2012;92(4):843–58, vii.
Brenner M, Hoehn M, Pasley J, Dubose J, Stein D, Scalea T. Basic endovascular skills for trauma course: bridging the gap between endovascular techniques and the acute care surgeon. J Trauma Acute Care Surg. 2014;77(2):286–91.
Soar J, Perkins GD, Abbas G, et al. European Resuscitation Council Guidelines for Resuscitation 2010 Section 8. Cardiac arrest in special circumstances: Electrolyte abnormalities, poisoning, drowning, accidental hypothermia, hyperthermia, asthma, anaphylaxis, cardiac surgery, trauma, pregnancy, electrocution. Resuscitation. 2010;81:1400–33.
Russell RJ, Hodgetts TJ, McLeod J, et al. The role of trauma scoring in developing trauma clinical governance in the Defence Medical Services. Philos Trans R Soc B. 2011;366:171–91.
Smith JE, Le Clerc S, Hunt PAF. Challenging the dogma of traumatic cardiac arrest management: a military perspective. Emerg Med J. 2015;32(12):955–60.
Coats TJ, Keogh S, Clark H, Neal M. Prehospital resuscitative thoracotomy for cardiac arrest after penetrating trauma: rationale and case series. J Trauma. 2001;50(4):670–3.
Davies GE, Lockey DJ. Thirteen survivors of prehospital thoracotomy for penetrating trauma: a prehospital physician-performed resuscitation procedure that can yield good results. J Trauma. 2011;70(5):E75–8.
Morrison JJ, Poon H, Rasmussen TE, Khan MA, Midwinter MJ, Blackbourne LH, et al. Resuscitative thoracotomy following wartime injury. J Trauma Acute Care Surg. 2013;74(3):825–9.
Morrison JJ, Mellor A, Midwinter M, Mahoney PF, Clasper JC. Is pre-hospital thoracotomy necessary in the military environment? Injury. 2011;42(5):469–73.
Morrison JJ, Stannard A, Rasmussen TE, Jansen JO, Tai NR, Midwinter MJ. Injury pattern and mortality of noncompressible torso hemorrhage in UK combat casualties. J Trauma Acute Care Surg. 2013;75(2 Suppl 2):S263–8.
Fallon MJ, Copass M. Southeast Alaska to Seattle emergency medical air transports: demographics, stabilization, and outcomes. Ann Emerg Med. 1990;19(8):914–21.
McLeod J, Hodgetts T, Mahoney P. Combat “Category A” calls: evaluating the prehospital timelines in a military trauma system. J R Army Med Corps. 2007;153(4):266–8.
Olson Jr CM, Bailey J, Mabry R, Rush S, Morrison JJ, Kuncir EJ. Forward aeromedical evacuation: a brief history, lessons learned from the Global War on Terror, and the way forward for US policy. J Trauma Acute Care Surg. 2013;75(2 Suppl 2):S130–6.
Mabry RL, Apodaca A, Penrod J, Orman JA, Gerhardt RT, Dorlac WC. Impact of critical care-trained flight paramedics on casualty survival during helicopter evacuation in the current war in Afghanistan. J Trauma Acute Care Surg. 2012;73(2 Suppl 1):S32–7.
Davis PR, Rickards AC, Ollerton JE. Determining the composition and benefit of the pre-hospital medical response team in the conflict setting. J R Army Med Corps. 2007;153(4):269–73.
Morrison JJ, Oh J, DuBose JJ, O’Reilly DJ, Russell RJ, Blackbourne LH, et al. En-route care capability from point of injury impacts mortality after severe wartime injury. Ann Surg. 2013;257(2):330–4.
Apodaca AN, Morrison JJ, Spott MA, Lira JJ, Bailey J, Eastridge BJ, et al. Improvements in the hemodynamic stability of combat casualties during en route care. Shock. 2013;40(1):5–10.
Penn-Barwell JG, Roberts SA, Midwinter MJ, Bishop JR. Improved survival in UK combat casualties from Iraq and Afghanistan: 2003–2012. J Trauma Acute Care Surg. 2015;78(5):1014–20.
Bailey JA, Morrison JJ, Rasmussen TE. Military trauma system in Afghanistan: lessons for civil systems? Curr Opin Crit Care. 2013;19(6):569–77.
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Rees, P.S.C. (2016). Pre-hospital Management of the Critically Injured Patient. In: Hutchings, S. (eds) Trauma and Combat Critical Care in Clinical Practice. In Clinical Practice. Springer, Cham. https://doi.org/10.1007/978-3-319-28758-4_3
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