British Surgeon: "Princess Diana might have survived if treated faster"

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Charles and others,

I find it always very interesting that every now and than a surge is
slowly rising, sometimes abruptly breaking only to come up a few weeks
or month later: mainly US members pick up the buzz words 'Diana', 'pre
hospital time', 'helicopter' or 'load and go' and soon the discussion
goes to the pro's and con's of European style EMS systems (read: load
and go versus stay and play). Always amazing that few if any Europeans
take part in this threats...

Without bothering you with details I would just like to put in a few facts.

#1 European style EMS systems resemble a patchwork of different ideas
and different run systems. The longer I read this forum the stronger I
believe this is not unlike many other developed countries, including the US

#2 The bulk of the EMS dispatches is non surgical and non trauma. In
Germany, a typical ground based system has less than 20% surgical
emergencies, and airborn system around 50% surgical emergencies. These
numbers apply to on-scene dispatches only. Any discussion of who should
care for the education, maintainance and structure of an EMS system
should thus bare this in mind.

#3 Though there is obvious a bias on rapid local treatment of an
severely injured patient, both based on decades of teaching and
tradition (Martin Kirschner's basic idea was to bring the doctor to the
patient rather than the other way round) as well as simple interpolation
from other medical specialties slowly science begins to emerge in the
system. Rising costs force to justify the enormous expenses and -
believe it or not - challenging data from the new world, suggesting
rapid transport times might be a good idea in some instances or minimal
volume load might improve survival gave reason to take a closer look at
what we are doing here.

#4 Load and go vs stay and play is thus no longer what is taught in
Germany (and that is the only country I can speak for). It has been
replaced by 'load and play' - rapid (and safe) transport without
negligating necessary treatment: secure airway by intubation, reduction
of displaced fractures, stop bleeding, secure iv access (remember, not
only volume can be given iv....)

#5 we are looking for reliable data: the traumaregister yet includes
more than 30000 patients (well, to the best of my knowledge) providing a
unique database for research. The new version will probably contain a
section on prehospital transport (not only time but device etc.)

#6 ATLS has been adopted and will slowly provide a proper and comparable
training for all members of the trauma team

#7 the aim is to build a trauma system. We have been discussing this
only recently, asking the question who big a center should be and what
impact this might have on hospital size structure.

Cheers!

Mathias

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