NCEPOD: Trauma - Who Cares? - London Health Programmes

4Prehospital careFigure 13. Prehospital Glasgow Coma Score and intubation140Number of patients120100806040200Not intubatedIntubatedFailed attempt15 14 13 12 11 10 09 08 07 06 05 04 03GCS(Table 37). This could be taken to mean that the score wasnormal. However, it is important that the GCS or AVPU isrecorded, so that any deterioration later in the patient journeycan be clearly and unequivocally identifi ed.Where the airway was at risk because of a GCS lessthan 9, intubation was performed in only 46/170 patients.Documentation of other forms of assisted ventilation was notedto be poor. Advisors considered that the airway/ventilatorymanagement could have been better in a substantial numberof patients, a number of whom had a lowered GCS (Figure 13and Table 38). Many patients who may have benefi ted fromintubation did not have this procedure performed because theappropriate skills were not available.Table 37. Prehospital AVPU scoreAlert 68Verbal 21Pain 17Unresponsive 21Subtotal 127GCS or AVPU not recorded 25Total 152Table 38. Prehospital AVPU score and intubationNotintubatedIntubatedFailedattemptAlert 68 0 0AnalgesiaThe administration of analgesia prehospital was documentedin 110/504 cases. The advisors considered that theanalgesia was inappropriate for 7/110 of these cases.In one such case it was felt that an overdose had beenadministered. In another case the administration of analgesiaVerbal 21 0 0Pain 11 5 1Unresponsive 13 8 0Total 113 13 147