Editorials

How much to do at the accident scene?

BMJ 1999; 319 doi: https://doi.org/10.1136/bmj.319.7218.1150 (Published 30 October 1999) Cite this as: BMJ 1999;319:1150

Spend time on essentials, save lives

  1. Matthew W Cooke, senior lecturer in emergency care (MWCooke@emerg-uk.com)
  1. Emergency Medicine Research Group, Centre for Primary Health Care Studies, University of Warwick, Coventry CV4 7AL

    The argument over how much care to give trauma victims at the scene of an accident reflects the development of the ambulance service Originally the ambulance service simply provided a means of transport to hospital. As such the best policy was to scoop the victim up and run as fast as possible to the hospital, where treatment was started—“scoop and run.” Extended training of ambulance personnel meant that more could be done at the scene. Training, however, was based around learning skills rather than patient assessment, so the skills may have been used without assessment as to whether the timing was correct. The concept of stabilise before transport was developed, forgetting that it may not be possible to stabilise the critically injured patient without surgery. The pendulum swung to overtreating at the scene. Accusations of wasting time appeared and the phrase “stay and play” was adopted. Where are we now in the swing of this pendulum?

    Preventable deaths in prehospital care are …

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