TORONTO, 4 June — Some time ago in Toronto I witnessed a car accident. A young man sped through a red light and smashed into another car driven by an elderly man with his wife. Both cars skidded onto the curb and hit pedestrians who were on the sidewalk including a young boy and his mother.
It was a horrible scene but the point is to comment on the speed and efficiency with which the police and medical emergency units responded. Within less than a minute- no exaggeration- police cars were on the spot, checking on the injured, apprehending the young driver who was unhurt, securing the area for paramedics’ arrival and talking to witnesses. The paramedics arrived in the next minute and immediately began taking care of the injured, not simply carrying them into the ambulance sand rushing them to hospitals but in giving them emergency medical assistance as they deemed necessary.
In most car accidents that result in death or permanent injury in Saudi Arabia, lives could have been saved if paramedics had arrived promptly and promptly administered the required medical assistance. Not to mention of course all the people who suffer any kind of health problem — from a broken leg to a heart attack — and need emergency service. They usually have to rely on a family member or friend to take them to the hospital because they knew there was no point in phoning for an ambulance and then waiting for an hour or more until it arrived.
According to the American Trauma Society, trauma is an injury caused by a physical force, most often motor vehicle crashes, falls, drowning, gunshots, fires and burns, stabbing or simple assault. Auto accidents are in first place as the number one cause of acute trauma. One of the elements that distinguishes trauma from other medical emergencies often associated with an older population is that trauma can strike anyone, regardless of age at any time. In fact, trauma kills more people between the ages of 1 and 44 than any other disease or illness. Of the nearly 100,000 people who die from trauma each year in the US, roughly half of them do so because of automobile accidents. Moreover, 11 million individuals in the US are temporarily disabled by trauma each year and 450,000 of those suffer permanent disabilities.
One of the key elements in reducing death and disability from trauma is an effective trauma system. This includes properly trained EMS (Emergency Medical Service) providers at all levels, an emergency department that can appropriately treat and care for traumatic injuries and an organized system that brings all of these diverse elements together to work as a team.
Like the treatment of many medical emergencies, particularly acute cardiac problems, time is of the essence in responding to potentially life-threatening traumatic injuries.
I spoke to the Acting Public Education Officer in Calgary whose EMS is ranked one of the best in North America. He said that their paramedics undergo a three-year training program that covers subjects ranging from effective communications and teamwork to advanced courses in anatomy, physiology, cardiac support, and pharmacology. They are also trained to deal with spinal injuries and using a defibrillator.
Their goal in response time is to be on the scene within 8 minutes or less in 90% of the time. Even the dispatchers are trained to answer emergency calls and advise the 911 callers situation before the arrival of the paramedics.
The first concern in dealing with any severely injured patient is to make sure the airways are clear and that the patient is breathing. Once the airways and breathing have been assessed and brought under control, attempts should be made to stop bleeding. A 40% blood volume loss — about 2000 ml.- in a 70 kg. patient, sustained for over two hours is lethal in healthy young adults. Every effort must be made to limit blood loss. If the patient is suffering from shock — which in most such cases, he or she is — the duration of shock must be limited by transporting the patient to definitive care as quickly as possible. Shock is defined as an inadequate supply of oxygen or nutrients to tissues and prolonged shock can lead to multiple organ failure. Prompt recognition and treatment of shock can avoid costly, prolonged intensive care unit (ICU) stays and unnecessary deaths. Whether it is better to bring the patient as quickly as possible to the hospital with minimum medical assistance or provide them with immediate and needed assistance at the scene of an emergency depends on the condition of the patient, doctors say. Definitive care is of course only in a hospital but paramedics can provide medical support on the way and often it is necessary to do so at the scene in cases of cardiac arrest.
Many early deaths are preventable with appropriate care. Early care of injured patients has to be improved by quick stabilization in the field and rapid transport to appropriate definitive care facilities.
Through continued training, education and expedient care of the seriously injured, paramedics can further reduce trauma-related mortality and morbidity. In a mass casualty incident, there is an even greater need for a quick and efficient response. Between 75%-85% of fatalities occur within the first 20 minutes of the event, usually before EMS contact.
In a 1983 University of Delaware Disaster Research Center study of 29 disasters, poor management is cited as a common problem and the reason for loss of light. Most people are won or lost in the first 10 minutes after arrival, when important decisions are made. These are the sorts of decisions, which must be made without delay.
Is the casualty count stable or potentially escalating? How many ambulances are needed and where should they be for best access and egress? Which patients need to get out first and which ones can wait? Where should the patients be transported? And the most important question is: How many people are injured or sick and how sick are they? A paramedic should have the specialized training necessary to answer these questions and do what is necessary in order to save lives and assist the injured. As physicians and nurses become available on the scene, they can be utilized to perform patient care.
According to some sources, a patient should be categorized in less than 60 seconds. I have concentrated on pointing out the need for trained paramedics to assist those injured on the roads because of the high number of deadly and disabling traffic accidents in Saudi Arabia. That does not minimize the need for trained and properly equipped paramedics to treat other medical emergencies. One very important emergency is sudden cardiac arrest (SCA). SCA kills 95% of the people it affects.
In SCA, the heart stops beating, resulting in a loss of blood flow to the brain which, if left untreated, will lead to brain damage and death. According to the AHA — the American Heart Association — with each passing minute a person is in SCA his survival rate drops 10%. Thus, a patient in SCA for five minutes has only a 50% chance of survival. That indicates the need for paramedics to be trained to deal with this and other medical emergencies.
