Phase 0: Damage control resuscitation in the pre-hospital and emergency department settings

Abstract

Pre-hospital trauma care was first formalized into a trauma course for ambulance personnel in 1962 by Drs. J.D. Farrington and Sam Banks [1]. The Emergency Medical System (EMS) has evolved significantly since then, with the expansion of the 911 system to include most of the United States and the development of a multi-tiered training system for emergency medical responders. At the basic level, the emergency medical responder may be a first responder who is trained in advanced first aid. The highest level ground-based emergency responder in the United States is usually a paramedic, who works under the auspices of a regional medical director and is trained in the use of various medications, intravenous fluid therapy, and procedures (e.g., intubation, needle thoracostomy) to stabilize patients en route to the hospital. Conversely, many European countries utilize physicians as the highest level ground-based EMS responder. Most rotary-wing aeromedical transport providers utilize flight nurses as the highest level medical emergency responder, while many fixed-wing aeromedical transport companies utilize physicians for long-range transfers. © 2010 Springer-Verlag New York.