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Fri, 22 Feb 2002 09:28:12 +1030

 Karim Brohi wrote: 

> I thought AVPU had died and gone to heaven. It 
> was murdered in its sleep by the more robust and 
> powerful Glasgow Coma Scale.AVPU is essentially 
> a bastardised GCS - and the weakest components 
> of it.If you wanted to trim the GCS (and why 
> would you - it only takes 5 seconds) you'd limit 
> it to Best Motor Response (in the upper 
> limb)AVPU is dead and gone.  Let it rest in 
> peace.KarimPS.  The Glasgow Coma Scale is so 
> powerful it's even, apparently, used in 
> Edinburgh 

Whist I agree somewhat with what the Honourable Member for Karim writes,

I would suggest that as Sue Rowndy (howdy Sue!) says, that it is still
taught in the pre-hospital setting in various institutions, that provide
pre-hospital care and transport to medical and trauma centres.

The reason AVPU is still hanging around is its simplicity and the ease
with which it can be quickly (albeit crudely) calculated to give an
INITIAL idea as to where a patients condition currently sits. In our
service it is taught as an adjunt to the GCS, but mainly for our
Volunteer Ambulance Officers in Country regions who have limited
training and exposure to the types of cases that AVPU and GCS are useful
for.
For medical professionals it is probably of limited value when the GCS
can give a more accurate and detailed indication of perfusion status and
head injury. 

I teach it to volunteers to give them an idea that if someone is in the
"PU" area of the scale, that their airway status could be in immediate
jeapordy and Paramedic, or Intensive Care Paramedic back up should be
urgently sought where possible. These volunteers in our community aren't
stupid people, they are just different from professionals in that they
often have a focus other than emergency medicine in their lives. The
challenge for those of us who teach them, in my opinion is to provide
them with effective techniques to allow them to make informed decisions
about their interventions at a basic level of care that doesn't demand
too much of their time. That way they stay as volunteers, rather than
leave because they think it's all too involved and that they couldn't
possibly provide an adequate service to their community because they
don't know enough. If we didn't have them in some of our remote areas,
it would cost our state a lot of money to put in professional staff to
provide an Ambulance service. 

Sorry this has digressed, but my point is the "KISS" principle is
appropriate at times, and AVPU can provide this for those with a lesser
knowledge of medicine. 

Yours Sincerely,
Chris Cotton,
Intensive Care Paramedic.
South Australian Ambulance Service. 

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