Term Paper on "How Can Pre-Hospital Care of Road Traffic Injuries Be Improved in Australia?"

Term Paper 13 pages (3472 words) Sources: 10

[EXCERPT] . . . .

Prehospital care includes all of the medical stabilization and attention given to an individual both at the event site as well as en route to the hospital. This treatment is crucial in that it is a significant determinant in the overall outcome of the patient and their treatment. Particularly in the case of traffic accidents, the quality and efficiency of prehospital care is a significant factor not only in an individuals recovery but even in their survival of more serious accidents. There are a number of factors which impact the quality and efficacy of prehospital care. Specifically differences have been observed in the nature of prehospital emergency care between rural and urban areas. The difference can be as great as 20 minutes. Finally, it is important to understand the interaction between in hospital and prehospital emergency care staff. It is ultimately their ability to work together which is responsible for the degree of success, efficacy, and efficiency of the life saving efforts engaged in by both parties.

Hypothesis:

A well trained and fully equipped crew able to stabilize the victim before transport will improve the victim's chances of recovery as well as relieving the pressure on hospital-based emergency staff, especially in the case of a multiple victim event

Rationale:

The incidence of fatalities and long-term injury from traffic accidents in Australia is significantly skewed negatively towards rural regions of the country. Though within major cities, the time and distance between road side and hospital is typically brief that is not the case for the majority of Australian residents. As such it is essential that the training and practice of first responders be at least as effective in the stabilization of a victim as the triage team in a regional medical center. Through a combination of first hand observation, interview, and qualitative review it is the goal of this project to determine what the current state of prehospital treatment is in the instance of traffic accidents as well as what if any improvements or changes can be suggested by both hospital staff and first responders.

Aims and Objectives:

1. Determine what type of training is standard for first response crews.

2. Determine what type of equipment is provided to first response teams.

3. Determine the average response time for first responders both in cities and in rural areas.

4. Address the types of injuries are most common in traffic accidents

5. Address the remaining inadequacies in the Emergency Health system

6. Determine the existing discrepancy between in hospital emergency care providers and first responders

7. Determine the steps being taken by hospitals to bridge the gap between internal and external emergency care workers

8. Evaluate the types of programs available to integrate inhospital and prehospital emergency care workers

9. Determine the manner in which emergency health professionals view such programs

10. Discuss the different types of overlapping knowledge which would be beneficial in such a situation.

11. Discuss potential cross training programs between internal and external emergency response staff

12. Discuss potential solutions to existing inadequacies in emergency medical response protocol.

Introduction:

First responders are the first line of defence for individuals who are victims of traffic accidents. While there are literally thousands of traffic accidents in any given city any given day, it is the ones resulting in the hospitalization of those involved that are of particular interest. It is these accidents which present a unique albeit tragic cohort which required study. Though of course the primary attention is and must be devoted to the victims of the crash, it is also important to understand the mechanics and protocols of the emergency response from first response through the admission of the individual to the hospital. These protocols as well as interactions between emergency health professionals presents a range of potential inadequacy and difficulty which must be studied thoroughly if the system is ever to evolve further. Currently one of the most significant challenges facing this field of study is the disparity in quality of care between urban and rural areas. In rural areas, there are not only fewer personnel, but there are also less financial resources for up-to-date training and equipment. As such, it is not uncommon for the response time to be longer as well as the quality of initial response to be lacking. Another significant issue facing researchers is the existing tension between first responders and emergency personnel within hospitals. There is a significant gap in perceived education as well as ability between the two. This existing issue is indicative of communication breakdown between parties.

There have been numerous studies conducted to address the issues and challenges facing first responders and emergency personnel. These studies all generally conclude that there must be a unification of emergency response protocol between states as well as an increased understanding between the first responders and the in hospital staff. Increased interdisciplinary training programs may ultimately result not only in more effective triage but also in the reduction of fatalities in less affluent areas. In some rural areas it can take as long as half an hour between the time of the accident and when an individual begins to receive emergency medical attention. Necessarily in such a situation where there is a prolonged period of time between the accident and treatment it is essential that the first response is the correct one based on protocols which would be absorbed in a more sterile setting.

An issue which must be addressed is the manner in which physicians and first response personnel interact. It is the firm belief of the researcher that physicians should at least in part be involved in the training of emergency first response personnel. Further, those first responders should have a concrete role within the emergency room ensuring the fewest number of fatalities as well as minutes spent intermediate to actual treatment. In an emergency situation, even minutes can mean the difference between life and death. Working together cohesively and approaching the event from backgrounds of mutual respect and understanding are ultimately going to result in the most positive outcome for a larger number of victims.

Literature Review:

The efficacy of prehospital care is a significant factor in the long-term outcome of accident victims. First responders are responsible not only for assessing the severity of the trauma but also stabilizing and transporting the victims to the nearest and best equipped hospital. Prehospital care is a difficult field to assess in that it has so many different contextual roles depending on the location, amount of training, and degree to which hospital staff are willing to integrate the outside perspective and assistance of first responders.

In Australia particularly is the great disparity between urban and rural area first response. On average it takes up to 20 minutes longer in rural areas for victims of accidents to be successfully retrieved from the accident scene even if they are not trapped or in need of specialist assistance (Atkin, et al., 2005). The longer the time between the accident and the actual admittance of the victim to a hospital facility the more likely the incidence of fatality or long-term incapacitation as a result of the injury. This time discrepancy has been shown to be the result of human error in many situations. As a result of the data regarding overwhelming human error in the instance of prehospital treatment or the lack there of resulting in fatality or long-term incapacitation the Ministerial Task Force on Trauma and Emergency Services was established (Mulholland, et al., 2009). This task force specifically addressed the issues uncovered in an extensive body of research regarding the reasons behind the seemingly excessive areas of specific deficiency as high as 180 specific areas of deficiency which needed addressed uncovered in a single study (Cameron et al., 2008).

A significant issue faced specifically in rural areas is the involvement of local citizens in emergency situations. Though it is sometimes necessary or even advantageous for individuals on or near the scene to free victims in the event of fire of a precarious situation. However in addition to good intentions, citizens and other volunteers also bring a lack of professional experience which may ultimately result in the further injuring of the victim. While it is readily apparent why the direct involvement of untrained individuals is potentially dangerous, less apparent is the inherent danger in semi-trained volunteers who are technically qualified in basic life saving techniques but are not qualified to attend more severe accidents (Veitch, et al., 2005).

The most significant problems with poorly trained, partially trained, or untrained personnel is that they could potentially exacerbate the existing injuries. This problem is most commonly seen in volunteer paramedics who feel more confident in their skill and knowledge and as such may attempt to act in a more advanced capacity than they are strictly qualified for. This problem has ultimately resulted in an increase in the amount of time spent at the accident site as well as the severity of the lasting effects of injury (Boyle, & O'Meara,… READ MORE

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