Jitendar P Vij

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© 2010, Jaypee Brothers Medical Publishers (P) Ltd.

All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the author and the publisher.

First Edition: 2010

Typeset at JPBMP typesetting unit

Health care facilities in many countries are mainly urban oriented. Seventy percent of Indian population lives in rural area. India has seen tremendous growth in economy and population over last decades. There is great disparity between demand and delivery of health care. The doctor population ratio is also inadequate. Crude death rate has decreased but still well behind target. Deaths due to preventable diseases have also decreased. Deficient prehospital life support care in acute illnesses and trauma contribute significantly to morbidity and mortality. Improper handling of accident scene and delayed transport of seriously injured also contributes significantly. If seriously ill/injured patients are handled by skilled personnel in prehospital settings, it will help us bring down mortality. Small interventions like cervical spine immobilization in trauma victims, providing oxygen and fluids in acute care can prevent further deterioration and can bring large change in quality of life. Minimal effective interventions in actue care settings can be cost effective. There is no concept of prehospital life support care in India. I congratulate Dr Kundan Mittal, Professor in Pediatric Emergency and Intensive Care who has highlighted this issue and brought out a manual on prehospital life support. This manual primarily 8discusses the issues like accident scene management, initial global assessment, technique to secure airway, providing oxygenation and ventilation, control of bleeding and circulatory support and efficient transport of all sick and injured patients. This will be useful manual for primary health care providers and paramedics involved in medical transport.

Trauma and acute illnesses will be leading causes of morbidity and mortality in India in coming times. Such cases must receive evidence-based treatment at the earliest possible even before the patient reaches the hospital which is called prehospital treatment. This modality is almost nonexistent in India at present. Therefore, it does not over-emphasize that this area needs very urgent attention. Prehospital Life Support Manual is focused exclusively on this area. India will need strong infra-structure and force of doctors and nurses with evidence-based knowledge and quality training for delivery of these services. This manual provides meticulous guidance and approach by these professionals in managing such patients effectively. Chapters have been written in simple and easy-to-understand language. A large number of relevant photographs, flow charts and tables at right spots deliver the message clear and loud. This also reflects hard homework of author in preparing this manual. This will make implementation of these guidelines easy in field in Indian circumstances. Chapters on assessment of acutely ill/injured, airway, circulation, basic life support, fluid therapy, trauma, drowning and infection control in prehospital settings including ambulance have been written on the basis of present available evidence. The author has adequately provided approach for preventing secondary and tertiary problems by suggesting continuous secondary 10assessment. The chapter on art of communication and breaking news is special one. The manual is a welcome guide on prehospital care of a critically sick patient and should become a must for all transport ambulance groups, nurses, doctors or other para-medicals who are taking up these challenges. This manual is recommended for any Indian curriculum, library or training program on acute care facility, nurse or doctor irrespective of whether he or she is a teacher or a student.

“Safe hands safe lives.” If you are not perfect in driving, then there is a chance, that you may endanger the lives of all the occupants and others. Similarly, if you are not attended by qualified persons when seriously ill, your life will be in danger. System of delivering ‘advanced health care’ in hospital setting is well established, but there is no system of prehospital life support in existence in India. Prehospital life support is an important and integral part of effective health care system. Prehospital life support includes extrication of trauma victims, assessment of all seriously ill and injured, initial stabilization, and arranging transport to appropriate level of care without doing further harm. The concept of prehospital care is not new in the west, but in developing countries like India, there is no concept of prehospital life support. Timely intervention in seriously ill patients will be of great help and life saving. It is difficult to reach at door step with advanced care, but if basic life support services are given by health care providers (primary physicians, nurses, paramedics, and others) in time at door step, the survival can be improved. This manual has been designed keeping in view the great need of prehospital life support care of acutely ill. This manual primarily focuses on the initial assessment using ABCDE”s approach, stabilization, and transport of acutely ill or injured patients to the appropriate facility.

The most difficult task is to say thanks and acknowledge the contribution of others. I am indebted and grateful to the following persons who have taught me concepts of humanity, basic pediatrics, basic acute care, working for common man, and also suggested and edited the topics at various stage of preparation of this manual. I feel my gratitude to the persons/publishers for their references used by me during preparation of this manual. Due to unavoidable reasons, I was not able to communicate personally to all of them. I am also thankful to M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi for printing this manual.