Tremendous growth in population, vehicles, economy and industries has increased the chance of accidents/injuries. Overcrowding, change in lifestyle, environment and poor access to advanced health activities are also contributing to morbidity and mortality. Many of the areas are manned by unskilled personnel. Many countries have brought down morbidity and mortality in relation to preventable diseases, chronic ailments, and many of acute illnesses which do not require intensive care monitoring. There are certain areas/illnesses where we are still fighting. Inadequate prehospital life support care and inefficient transport system in acute illnesses also contribute significantly. Many lives can be saved if such patients are provided efficient prehospital and transport care in acute stage.
In prehospital setting seriously ill patients require, initial assessment using visual and auditory clues, ABCDE's approach, and stabilization before transport. In case of trauma victim the “Golden period” of management is important for functional survival. In many countries there is no transport policy and guidelines. There are also no prehospital life support services available. Our health facilities are primarily urban oriented and there is no concept of regionalization of services. Government sector is trying best to handle all the sick patients yet inadequate. Private or corporate sectors are out of reach to the common man. In our country though we have sufficient private/public transport facility and well connectivity but these transport vehicles (ambulances) are neither well equipped nor managed by skilled staff. Few of the centers in India do have well equipped ambulances but they are rarely managed by skilled personnel. In recently concluded study by author it was observed that most of the medical transport occurs like “scoop and run” and 2carried by unskilled persons. Also there is no concept in existence regarding prehospital care of acutely ill and medical transport. There is no data available about adverse events occurring during transport in India, though many deaths have been seen due to improper transport. If the primary responder or paramedics are well trained in handling the acutely ill and trauma patients which includes initial assessment, prioritization of intervention, securing airway, providing effective breathing, control of hemorrhage, and effective medical transport then we will be definitely able to bring down morbidity and mortality. Good communication skills during acute care are also important part of management. Frequent counselling of patient/family parents is required. One may also be involved in breaking the bad news in acute care. This manual primarily focuses management of acute illnesses in prehospital settings by prehospital life support provider including medical transport and counselling of seriously ill patients.