Prehospital advanced trauma life support (ATLS) is controversial because the risks, benefits, and time required to accomplish it remain unknown. We studied 70 consecutive patients with penetrating cardiac injuries to determine the relationships among prehospital procedures, time consumed in the field, and ultimate patient outcome. Thirty-one patients sustained gunshot wounds, and 39 had stab wounds. The mean Revised Trauma Score was 2.8 +/- 0.5. Paramedics spent an average of 10.7 +/- 0.5 minutes at the scene. Seventy-one percent of the patients underwent endotracheal intubation; 93% had at least one IV line inserted; and 57% had two IV lines inserted. Twenty-one (30%) survived. There was no correlation between on-scene time and either the total number of procedures performed (r = .17, P = .17) or IV lines established (r = .06, P = .6). On-scene times did not differ regardless of whether endotracheal intubation or pneumatic antishock garment applications occurred. We conclude that well-trained urban paramedics can perform multiple life-support procedures with very short on-scene times and a high rate of patient survival and that prehospital trauma systems require a minimum obligatory on-scene time to locate patients and prepare them for transport.

译文

院前高级创伤生命支持 (ATLS) 是有争议的,因为完成它所需的风险,收益和时间仍然未知。我们研究了70例连续的穿透性心脏损伤患者,以确定院前手术,现场时间消耗和最终患者预后之间的关系。31名患者受枪伤,39名有刺伤。平均修订创伤评分为2.8 +/- 0.5。医护人员在现场平均花费10.7 +/- 0.5分钟。1% 的患者接受了气管插管; 93% 插入了至少一条静脉输液管; 57% 插入了两条静脉输液管。二十一 (30%) 幸存下来。现场时间与所执行的程序总数 (r = .17,P = .17) 或所建立的IV线 (r = .06,P = .6) 之间没有相关性。无论是否发生气管插管或气动抗冲击服装应用,现场时间都没有差异。我们得出的结论是,训练有素的城市护理人员可以执行多个生命支持程序,现场时间非常短,患者生存率很高,并且院前创伤系统需要最少的强制性现场时间来定位患者并为他们做好准备运输。

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