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Pre-hospital
emergencycareRequirements for an
emergencymedical serrrice
PG LANDSBERG MBBCh MFGP(SA)
Medical Officer, SA Fire ServicesInstitute, Benoni
KEYWORDS:Emergency
HealthServices;
Disasters;
CriticalCare;
Organisation
occurwith
T-\ISASTERS, bothnaturalandman-made,
I-f little or nowarning,andthe problemsthey createat the
time and during subsequentinvestigations,justify the
effortsinvolvedin attemptingto anticipatetheir effectsl
The aim of an emergencymedical system (EMS) is to
provide a critically ill or injured patient with the earliest
possiblelife-savingmedical
treatment.The essentia-ls
of an
EMS areasfollowsl
SI.]MMARY
The aim of an emergencymedical
service is to provide ill or injured
patients with early life-saving
medical treatment. Basic requirements for such a service are given.
Thecallforhelp
The persondiscoveringthe casualtyor disasterinitiatesthis
callby telephone,radioor messenger.
A well-publicised
call
systemwill avoidconfusion,delayandpanic.
Immediate on-site first-aid
No matterhow efficientthe EMS, if thepeoplewhodiscover
the casualtyarenot trainedin first-aidandcardiopulmonary
resuscitation,many iives will be lost asa result of bleeding,
asphyxiaor unconsciousness.
All 'first responders'in the EMS shouldbe trainedin Basic
Life Support according to the internationally accepted
standardsof cardiopuimonaryresuscitation(CPR) of the
AmericanHeartAssociationl
All training organisations,includingthe First-Aid Societies,
shouldabideby theseinternationalstandards.
Dispatch of the correct help
The centralcontrolroom,in commwricationwith the whole
EMS, evaluatesthe call and sends the necessaryhelp.
Opinionsdiffer regardingtheusefulnessof a medicalteamat
the disastersite, but if the circumstancesjustify sending
doctorsand nurseswith first-aid personnelto the disaster,
their efficient operation will depend on their training,
SAJOURNALOFFAMILYPRACTICE MARCH 1984
pre-hospital emergency care
organisationand equipment.Medicalpersonnelwill need
protectivehelmets,foofwearand waterproofclothing.It
may not be safe to send female medicalpersonnelinto
potentiallydangerousdisasterareas,and for this reason
trainedparamedical
malepersonnelareessential.
The doctor interested and kained in Emergency
Medicineahasthe mostimportanttask of Triages(sorting
out casualtiesin orderof life-threatening
conditions)at the
disaster
site.
Paramedical personnel
It isvirtuallyimpossible
in alargecommunityto senddoctors
and mrses to the site of a disasteror even a medical
emergency.The personneldispatchedin responseto an
emergencycall should be well trained in first-aid and
resuscitation.
cardiopulmonary
Communications
In aimost every reported disasteror disasterexercise,
commuricationshave failedl All elementsof the EMS
shouldhavevoicecontact.The controiroomcommunicates
with fire, rescueemergency,policeand traffic vehiclesas
well aswith thehospital,andwith othercontrolrooms,and
has a call system for key personnel.Three separate
communication
linksarerequiredby themedicalteamlviz.
accessto the emergencyradionetworkof the policeor fire
team,a directradiolink betweenthe medicalofficerat the
disaster and receiving hospital, and inter-personnel
communication
at thesceneof thedisaster.
Transportation
A completeEMS hasthe supportof fire-fighting,rescue,
emergencyand ambr.rlance
vehicles.Rescuevehiclesare
used to extricate casualtiesfrom wrecks; emergency
vehiclesare designedto allow effectivetreatmentof the
casuaityat the site, and have sufficientlife-supportand
monitoringequipmentfor useduringtransit.Ambu,lances
areusedfor thetransportof lessseriouslyinjuredcasualties.
ilffi:f o J:?H"
Hospitals
Onehospitalin the areais the receivinghospitalandothers
aresupportinghospitals.Hospitalsmaketheirou.ninternal
arrangementsin the casualtyand intensivecarer.rnits,but
the importance of collaborationbetween the hospital
service,fire,policeandtheEMS mustbeemphasised
sothat
no confusionoccurs when all the servicesare u'orking
togetherin a large-scale
errergency.
Localauthoritiesareresponsible
for theoveralicivil defence
pianning,and haveto rely on the doctorsin their areasto
adviseandactivelyassistwith the formationof an efficient
EM56.
Disasterplanningremainsa difficultandr"urpopular
taskfor
very busypeoplehamperedby publicapathy,lack of funds
and,in certaincases,a disregardfor medicalprioritiesby the
localauthorityl The final test for an efficientcivil defence
plan will be a properly designedexercisesimulatinga
neverseemimminent,andwe must
disaster.Catastrophes
acceptthe ironythat,asplanningandtrainingcontinue,the
systembecomesbetter gearedto handlean eventwhich
everyonehopeswill neveroccurti
REFERENCES
1 LeadingArticle (1972): B ri 1.X'lerl.J.,3.3.
2 Haeck.W.T. (1973):
llospik Is,47,139.
(CPR)anclemergency
3 Standardsfor carcliopulmonary
resuscitation
cardiaccare(ECC),(L974):JamaSupplementVol. 227,7, 8,33.
4 CouncilonMedicalEducation(1973):Reporlonthe Educationo{the
Physicianin emergenc-v
medicalcare.Chicago:Americanmedical
association.
5 EmergencyCareandtransportation
of thesickandinjured(i977):
AmericanAcademyof OrthopaedicSurgeons430North Michigan
Avenue,Chicago,
illinois60611.GeorgeBanta& Co.(lnc.)Menasha.
Wisconsin,
6 SA FireServices
Institute,P.O.Box613.Krugersdorp
17.10(197+,
I976):CivilDefence
Sy'rnposia.
7 I-andsberg,
P.G.(1980):
Emergency
MedicalSer-vices
in CivilDefence
in:DsasterMedirine,
Eds.MacMahon,
A.G.,&Jooste,M. A.A.
Balkema,
CapeToun 36-38.
VOCATIONAL TR{INING FOR FAMILY
PR,C.CTICEINISRq.EL
A betterunderstandingof the problemsof physicianswho
misuseal<nhol
andclrugshashelpedintheearlyrecognition
and
treatmentof a chemicaldependence.
fieatment programs,
particularlythosewhichrecognize
physicians'
specialneeds,
Manyaddicteddoctors'needsare
reporthighratesofrecovery.
ro1e.Their imageoftenbecomes
an
relatedto thef professionai
in.ithcolleagues
frequently
obstacletotreatment.Relationships
makeit difficultto get help.Thesespecialproblemsusually
reflectnegativeattitudesandmoralisticjudgmentsw'hichare
The earlyrecognitionofa dwelopingdepender.rce
rurwan-anted.
is encouraged
by informalprogramsof assistance
andan
advo<zc1'
riclefor theprofession.
Awarenessthat the competentfamiiyphysicianin the communiryisthekeypersonin providingeconomic
andeffective
healthservicesisincreasing.
h lsrael,asin mostWestel'ncounvocational
tries,thisneedisbeingmetby postgmduate
trainingin familymedicine.kr Isael, the4-lrcurriculum,aftercompletionofthecompulsoryinternshipyear,consistsof27months
in approvedhospitalwards,followedby
in rotatingresidencies
21 monthsin approvedteachingpractices.ur-rder
the supervisionof familyphysician
tutors.Aformalcourseofacademic
studiesorivork in oneof thebasicmedicalsciences
isrequired,
asaretheBoardofFamilyMedicinemandatc"rryexaminations.
NowitisnecessarTtoreachaconsensusonthefuture
scopeand
contentof lamilymedicineasanindependent
disciplinetliat can
providecomprehensive,
continuous,
accessible,
andcoordinatedhealthcaretoallfamily rnembersin thepracticepopulation,bothin theirhomesandin clinics.Thereisalsoa needto
recognizethat academicandclinicalteachingandresearchare
asmuchaparlofthefamill'physician'staskashisservice
comn.ritment.
andthatadequte facilitiesmustbeprovided.
Henderson, HW
Fami11,
Physician
Canadian
Vol 29:1983(1853- 1855)
Polliack,Max R (Dept.of F'amilyMedicine,Tel Aviv
Universit-v).Ls
rJ Mad9i Yo119:1983(783- 786).
ADDICTED DOCTORS; RESPONDING
TOTHEIRNEEDS
SA HT-ISARTSPRAKTYK MAART I984
i8
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