Prehospital trauma care systems - World Health Organization

7.TRANSPORTATION AND COMMUNICATION
7.1.2 Air medical transport
In places where airborne medical services are available, their use may markedly reduce
the time required to transport a victim to a facility for definitive care and may thereby
maximise his or her chance of making a successful recovery. In remote locations, air
transport may be the only means of reaching a health-care facility.This is particularly
true when transportation involves travel over rugged terrain.
The costs associated with developing and maintaining an air transportation capability
(such as a helicopter or fixed-wing transport), include the purchase, operation,
maintenance and training of crew.These costs are extremely high. For example, in the
United States of America, the annual cost of operating an airborne medical programme
is estimated to be about US$2000 per transported patient (56, 57). In the United
Kingdom, the cost per mission varies between £515 and £2235 (58). Many countries
will find these costs prohibitive and thus reasonably conclude that improving existing
modes of transportation (or devising affordable alternatives) may be more feasible.
Where air transport is available, well-defined criteria are needed to ensure wise
use of this resource.Various approaches can be adopted to organize and support a
medical air transport service.Whether financed privately, supported by a charitable
group, based on a military model or run by the government, collaboration with local
citizens, health-care providers and health-care institutions is essential.
7.2 Importance of field triage
Triage is the term applied to the process of classifying patients according to the severity
of their injuries to determine how quickly they need care. Careful triage is needed to
ensure that resources available in a community are properly matched to each victim’s
needs. If too many patients regularly bypass the local clinic in favour of the regional hospital,
the latter facility will be overwhelmed. If, however, severely ill or injured patients are seen
at a local clinic rather than being stabilized and promptly transferred to a facility providing
a higher level of care, needless deaths will result. If a victim has sustained devastating injuries
and the nearest hospital is more than a day’s travel away, it may be more prudent and even
compassionate to provide palliative treatment at the local level instead of subjecting the
patient to the discomfort and rigours of a transfer that he or she may not survive.
Formal algorithms or protocols must be developed to ensure that community
resources are used properly to care for trauma patients; these algorithms must exist
for both the prehospital and hospital setting. Failure to develop protocols may lead to
over-triage or under-triage.
Over-triage
Over-triage occurs when non-critical patients are sent to facilities offering the highest
level of care; the facility thus expends resources treating patients who have minor injuries
or complaints. If this occurs, the hospital’s staff may be too busy to properly focus their
attention on more seriously injured patients. In situations in which there are numerous
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