Letters Doctors on the front line

Time for a civilian front line?

BMJ 2010; 340 doi: https://doi.org/10.1136/bmj.c1318 (Published 10 March 2010) Cite this as: BMJ 2010;340:c1318
  1. Janos P Baombe, doctor1
  1. 1Emergency Department, Manchester Royal Infirmary, Manchester M13 9WL
  1. baombejp{at}yahoo.co.uk

    War changes medicine: how will the wars in Iraq and Afghanistan change the management of trauma in civilian life?1

    The original AcBCDE approach to trauma management—airway with cervical spine immobilisation, breathing, circulation, disability, exposure—has needed in these conflicts to become cABC (catastrophic bleeding, airway, breathing, circulation).1 Increasing sport activities and high speed road traffic collisions have led to more patients with multiple injuries and severe haemorrhage being treated in emergency departments in developed countries. Aggressive blood resuscitation and control of coagulopathy are often paramount but seem not to fit well with the AcBCDE approach. We in emergency departments should therefore be flexible and adapt algorithms to the clinical needs, just like doctors on the front line.1

    As well as shock packs and a low threshold for using O negative blood, the design of emergency departments and trauma centres needs to be changed to minimise the distance from the receiving unit to operating theatres and imaging centres. In Macdonald’s article the chain of care starts on the field with robust prehospital care and continues in a centre where a single multidisciplinary team awaits the patient with operating theatres and imaging centres nearby. This should be our objective for emergency departments.

    I wonder when such effective coordination and condensed communication between teams will be attained, with patients being stabilised outside hospital before transfer straight to an operating theatre-imaging centre without passing Go.


    Cite this as: BMJ 2010;340:c1318


    • Competing interests: JPB is an ATLS instructor.


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