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
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Vested interest and other reasons unconnected with the optimum
management of trauma are why such a letter as this needed to be written.
Even today in my region there is pressure to retain more A&E
departments than can reasonably be supported by the appropriately trained
medical and other staff with the necessary infrastructure.
To be optimum, appropriate management needs to be commenced at the
scene and be continued all the way to the fully equipped and resourced
receiving hospital which journey might take some time.
Leaving aside the required hospital components, which can only come
from having fewer receiving centres, what needs to happen?
First, the receiving A&E must have 24 hour staffing by emergency
Secondly, an appropriate number of emergency vehicles (land and air)
properly equipped for active management during transfer must be staffed
with an advanced paramedic or, better still, a doctor.
Thirdly, communication is key and, in 2010, surely, not a difficult
problem with mobile phone technology and easy wireless access, allowing
the trauma lead on the vehicle to be in constant two way contact with the
receiving emergency medicine specialist (including the transfer of data).
Where might the doctor come from? Secondments from and a component
part of the training package for emergency medicine, anaesthesia, surgery
and even other specialties would fit the bill. Someone with access to and
knowledge of the numbers would need to look at this but it should be
Competing interests: No competing interests