Trauma Care Conference UK March 2017 – PHEM/HEMS stream

Last week was the international Trauma Care Conference, based at Yarnfield, Staffordshire, UK.  It ran for several days, with something for everyone in the management of trauma, from the moment of impact to the long difficult process of rehabilitation.  I attended the PHEM/HEMS stream on the Thursday, and the Major Trauma in the ED stream on Friday.  Below are my notes for the PHEM/HEMS stream.  Some of these points I tweeted live from the conference, but much of it may be new. My notes from day 2 are here.

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Traumatic Brain Injury: Hypertonic Saline or Combination fluids?

The use of fluids prehospital has always been, and will likely continue to be a controversial topic.  The simple notion that we should be replacing the fluids which have been lost is sensible and logical, but not necessarily logistical.  The logistics of carrying blood products make it unfeasible for many services, and certainly on a large scale for widespread use within an ambulance service. Continue reading “Traumatic Brain Injury: Hypertonic Saline or Combination fluids?”

Major incident management – in brief…

Recent years have seen some real thought put into major incident management in the UK, particularly after such high profile incidents such as the rail crashes at Paddington, Potters bar, and Selby, and large scale terrorist activity like the Glasgow and London bombings.  The July 7 2005 bombing incident highlighted many areas which still needed urgent attention including command and control, and communication.

What do I do if I’m first on scene? Continue reading “Major incident management – in brief…”

Palliative trauma care: Should we always intervene?

Prehospital care and inhospital trauma care have seen some amazing advances over the last few years.  Patients are receiving critical care level interventions not just in the emergency department, but at the point of impact.  It is difficult to judge who will benefit from these interventions; patients with traumatic brain injury (TBI) can continue to improve rapidly for six months and then gradually for years after that; those with seemingly unsurvivable injuries can sometimes reach hospital discharge and go on to rehabilitation.
I am often faced with a prehospital dilemma.  Should we always provide those interventions?  Should we always go all out to save a life?  At what cost?  My critical care colleagues have said that they are seeing a new type of patient these days – the ‘palliative trauma patient’; those who my colleagues know to have injuries that will ultimately defeat them.

Continue reading “Palliative trauma care: Should we always intervene?”