Trauma EMS : PAST, PRESENT AND FUTURE Rao R. Ivatury MD, FACS, FCCM Richmond, Virginia
Trauma EMS : PAST, PRESENT AND FUTURE COI: None
EMS Creed Somewhere deep within us our souls are crying out, We're here to help our neighbors in their hour of pain and doubt. God gave us something special to help us see you through, we do it cause we love you and we care about you too. -Author Unknown
The fate of the wounded rest in the hands of the one who applies the first dressing Senn
Trauma EMS : PAST, PRESENT AND FUTURE Objectives : 1. Evolution of the prehospital care and EMS 2. Current state of art of EMS 3. Projections for future advances in pre-hospital care
First Medical System Edwin Smith Papyrus : 3000-2500 B.C. Aashoka in India! 273-232 B.C.
Dhoolies
HISTORY OF TRAUMA CARE Napolean s Chief Surgeon : Baron Dominique-Jean Larrey (1766-1842): developed the first system of field care ( flying amb, Field hospitals) U.S. Civil War (1861-1865) : Battle of Bull Run : Delay in evacuating soldiers with increased casualties
HISTORY OF EMS 1862 September : Surg General Hammond appoints Letterman as Director of Army Defined the structure and functions of ambulances, two wheeled versus four wheeled, triage, 9000 soldiers transported and treated
HISTORY OF EMS 1860's: First recorded use of a field ambulance : The Civil War. 1865: First ambulance : The Commercial Hospital in Cincinnati Grady and Charity followed
HISTORY OF EMS 1869: NYC : Bellevue : their first 74 calls 1869 1466 calls by 1870 4392 calls by 1891
HISTORY OF MVC 1865: First fatality of a young woman in London, hit by a car at 4 MPH! 1899 : First fatality in NYC. 68 yrs old Stepped off the curb and crushed by a electric car. 74 and Central Park West
HISTORY OF EMS 1883
HISTORY OF EMS 1890: The Williams family of Gainesville runs their first call for help using a horse drawn funeral carriage. 1909: The American Red Cross begins its first aid training program.
HISTORY OF EMS Tandem Ambulance, 1904
1912
HISTORY OF EMS 1918
1914 First Trauma Unit
The first motorized ambulance Michael Reese Hosp, Chicago Weighed 1600 lbs Battery powered Trvelled at 16 mph St. Vincent s in NY
The first aircraft ambulance In 1910 Built in NC, flew in Florida Crashed after 400 yards
The first aircraft ambulance September 6, 1901: First US President in ambuance: McKinley Buffalo, NY
1914-1918
1914-1918
1914-1918
HISTORY OF EMS 1922 The American College of Surgeons (ACS) establishes the Committee on the Treatment of Fractures
HISTORY OF EMS Fire Departments 1934: Columbus, Ohio begins a Basic Life Support (BLS) squad 1959: Los Angles Fire Department initiates a BLS response with extrication and first aid equipment
1937
HISTORY OF EMS 1959
HISTORY OF EMS
HISTORY OF EMS Medical Associations 1964:American Academy of Orthopedic Surgeons : 3-day course for training of emergency medical personnel 1965: The AMA: commission to study EMS
HISTORY OF EMS 1966: The National Academy of Sciences NRC: Accidental Death & Disability: The Neglected Disease of Modern Society
HISTORY OF EMS 1966: The National Highway Safety Act (P.L. 89-564) : national standards for training EMTs and minimum equipment required on an ambulance.
HISTORY OF EMS 1966: The National Traffic and Motor Vehicle Safety Act DOT empowered set MV standards, develop EMS systems
HISTORY OF EMS Accident Prevention : National Council on Accident Prevention Emergency First aid and Medical Services: Standards in Education and training of health care personnel Ambulance design and equipment Automotive and air transport in rural areas
HISTORY OF EMS Emergency Departments Needs - survey of the number and types Federal fund support to design, construct and in part, operate Development of a mechanism for inspection, categorization, and accreditation
HISTORY OF EMS Trauma Unit March 1966 : nation s first trauma center at Cook County Hospital (CCH) in Chicago Drs Robert J. Freeark, Robert J. Baker immense patient load, heavily weighted in emergencies and trauma
HISTORY OF EMS Trauma Registries Establishment of trauma registries in selected hospitals to continue to evaluate the natural history of the various forms of injuries.
HISTORY OF EMS 1969: COT of ACS, and the Committee on Injuries of the AAOS, and The Division of EMS develop basic definitions and establish guidelines for delivery of emergency care.
HISTORY OF EMS Results of "White Paper" 1969: LA initiates ALS response. 1970: Seattle, Washington goes ALS. 1971: Nassau County, LI Grand Rapids, Michigan train police/paramedics.
1970: NHTSA mission is to save lives, prevent injuries and reduce traffic-related health care and other economic costs. The goal of NHTSA's EMS Division is to develop/enhance comprehensive EMS systems to care for the injured patients involved in motor vehicle crashes.
EMS Agenda For the Future EMS of the future will be communitybased health management fully integrated with the overall health care system. identify and modify illness and injury risks, provide acute illness and injury care and follow-up, contribute to treatment of community health monitoring
HISTORY OF EMS 1973: The United States Congress enacts the EMS Systems Act providing $170 million to enhance EMS over a three year period. Trauma systems identified as essential 1975: Seattle study shows improved survivability of heart attack victims with early intervention of Advanced Life Support (ALS).
HISTORY OF Trauma 1976 : ACS : Optimal Hospital Resources for Care of Injured Patient
R Adams Cowley
HISTORY OF Trauma 1985 : NRC and IOM publish: Injury in America : A continuing Public Health Problem
HISTORY OF Trauma 1990 : Injury Control Act Establishes division of Injury epidemology and control at CDC
NREMT NAEMT
Pop Culture For EMD : William Shatner s post Star Trek life began Rescue 911 : teacher of public safety access and pre-arrival instructions in the late 1980 s Emergency! for ED Docs and Paramedics ER in the late 90s and 2000s introduced the specialty American households MASH and the trauma surgeon and nurse
Future Trends in EMS Regionalization of Care in Trauma Cannot overtax Level 1 centers So where do EMS systems go? Level 2 s? Level 3 stabilization centers? Challenge of differential triage
Challenges Tough patients: The young The elderly The intoxicated
Controversies Spinal immobilization?field clearance How much sedation? Or paralysis? How much resuscitation?
More Controversies? MAST? Intubation? Scoop and run Or Stay (and play) in place
More Controversies? Scoop and run Or Stay (and play) The sniper story of VA
ON THE HORIZON Bleeding control Rapid intubation Imbedded sensors Field pronouncement
ON THE HORIZON Hypertonic saline Antioxidants Blood substitutes Hypothermia Sonography Point-of-care
ON THE HORIZON Better equipment, interchangeability Digital EMS Integration of : systems,equipment industry Video Imaging
ON THE HORIZON Distant learning Patient sims More academic More judgement based care Better Education
ON THE HORIZON Better, faster transport Better and faster communication Better and faster treatment ( damage-control )
DAMAGE- CONTROL AT GROUND ZERO
GROUND ZERO : Places of our activity America s uncivil war
Damage control Experts
Extrication
A,B,C s Spinal integrity Bleeding control ED prep
Fracture Immobilization Brain & Spinal cord protection
300,000 In 26 countries Survival 5%
David R. Boyd MD Living legend of EMS
Thank you!!