Polytrauma: a case report

In a prehospital setting, the ‘foot of the bed inspection’ becomes an ‘over the ambulance dashboard inspection’. A mangled wreck at the foot of a tree is usually a good indication that someone has been injured, although mechanism alone has not been proven to be an accurate predictor of trauma severity (Boyle, 2007). A systematic approach incorporating both the mechanism of injury and physical assessment reinforces the index of suspicion and helps determine whether or not the patient is time critical.

The introduction of ‘Golden Hour’ and ‘Platinum Ten Minutes’ has arbitrarily and unwittingly contributed to a target driven prehospital environment that is arguably governed by the clock and not the clinician. Now, in the midst of NHS reconfiguration, hospitals come trauma centres are set to become bigger and better— and much further apart.

Longer transfer times will mean that the ‘scoop and run’ option will not necessarily be the best course of action for seriously ill and injured patients—paramedics and doctors simply have to get better at looking after them in the field. As paramedics’ assessment skills improve and doctors gain prehospital experience, it is anticipated that a well balanced team will emerge—a team that is aware of their limitations and limit their interventions to the time permitted to intervene.