Prehospital Care and In-Hospital Initial Trauma Management

Abstract

Trauma care is a time-sensitive emergency. Prehospital and in-hospital early care are the two necessarily interlaced crucial phases in the management of severe traumatic injuries, with potential impact on the survival of patients. While the main goals of an effective prehospital trauma system are clearly recognized, the relative impact on patient’s outcome of different approaches has yet to be established. The diversity among healthcare systems of different countries and the scarcity of high-quality evidence make it difficult to reach a consensus on essentially every aspect of prehospital trauma management. Once arrived at the selected trauma center, within dedicated areas of the emergency department, trauma victims should be assessed and treated by a specifically trained multidisciplinary trauma team, directed by a team leader, according to pre-specified institutional algorithms. Following a classic ABCDE method, thorough stepwise evaluations of the patient, and simultaneous emergency damage control maneuvers, are performed, prior to directing the patient to a definitive care plan. The management of trauma patients involves extremely complex logistics, across several levels of any healthcare system. Multiple providers with different training, both pre- and in-hospital, are called to face technical, organizational, clinical, and communication challenges, in a significantly time-constrained situation.