Oxford Handbook of Pre-hospital Care (Oxford Medical Handbooks)

753 Pages·2021·14.368 MB·English

by  Ian Greaves, Sir Keith Porter

PMS 269C PMS 7414C PMS 562C
the first port of call for those first
at the scene
Fully updated for a second edition, the
Oxford Handbook of Pre-Hospital Care is the
invaluable guide to providing high-quality care
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6 poisoning
7 acute psychiatric
emergencies Greaves Provides comprehensive key information for all
We value your feedback.
8 child health Visit www.oup.com/uk/medicine/handbooks Porter immediate care practitioners
to give us your comments on this book.
9 the hostile environment Fully updated with the latest training and regulation
0 major incident Review from the previous edition: standards and JRCALC guidelines
management and triage '… a concise book which is targeted directly to
our profession...this one book is directly focused
 chemical, biological, on the workings of the medic outside of a hospital Provides all the essential knowledge for the DipIMC
radiological, and
environment. Just what you need out on the road,
nuclear incidents
when you never know what the next emergency
2 emergency obstetrics, will be.' (Jeff Pittman, Paramedic)
gynaecology, and
care of the newborn
3 patient rescue and
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OXFORD MEDICAL PUBLICATIONS
Oxford Handbook of
Pre- Hospital Care
ii
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OXFORD HANDBOOK OF 
Pre- Hospital
Care
SECOND EDITION
Professor Ian Greaves
Consultant in Emergency Medicine, James Cook University
Hospital Middlesbrough and British Army
Professor Sir Keith Porter
Professor of Clinical Traumatology, Queen Elizabeth Hospital,
University Hospitals Birmingham NHS Foundation Trust, UK;
Former Chairman, Faculty of Prehospital Care, Royal College
of Surgeons, Edinburgh
1
iv
1
Great Clarendon Street, Oxford, OX2 6DP,
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First Edition published in 2007
Second Edition published in 2021
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v
Foreword
The importance of good pre-hospital care in the most seriously ill or in-
jured cannot be overemphasized because the most effective in-hospital
care may be ineffective if patients are delivered to hospital in a poor state.
Pre-hospital care is rapidly evolving and standards are constantly improving
resulting in more consistent, high-quality care. Although much of the work
we do is predictable, the pre-hospital workspace will regularly challenge
and surprise us. That is one of the reasons why we continue to recruit
high-quality clinicians to this sometimes arduous area of practice. The
second edition of this Oxford Handbook is timely. It reflects the consid-
erable changes in treatments, techniques, new technologies, and improved
training that have emerged since the first edition in 2007. Not least, in the
intervening period, Pre-hospital Emergency Medicine has become a recog-
nized sub-speciality in the UK. This book provides comprehensive informa-
tion on the commonly encountered emergencies in pre-hospital care like
cardiac arrest and trauma. Less common things may generate more anxiety,
and just as importantly, we are provided with the knowledge to manage
less commonly encountered clinical situations like obstetric and paediatric
emergencies and major incidents.
Pre-hospital practitioners tend to be practical people. They want to
know what works best, how they can alter practice to reflect evidence and
guidelines, and how to deliver the best care without missing anything. The
Oxford Handbook format is an excellent vehicle to achieve these object-
ives. Despite the ready availability of electronic information, generations of
clinicians continue to rely on the Oxford Handbooks as trusted and relevant
sources of information on which to base their clinical practice. Not only is
this Handbook wide ranging, but its clarity will appeal to the wide range of
clinicians who work outside hospital.
The authors of this Oxford handbook bring decades of experience as
authors, clinicians, and leaders. They have once again delivered a clear but
comprehensive guide to help us deliver the high-quality care that we all
aspire to.
Professor David Lockey MB BS MD(Res) FIMC RCS(Ed)
FFICM FRCA FFSEM
vi
vi
Foreword
Back in 2006, it was an honour to write a foreword to the first edition of
this pocket-sized, comprehensive guide which covered the extensive variety
of conditions encountered in immediate care outside hospital. This little
book, small enough to fit into a practitioner’s response bag, Hi Viz jacket
pocket, or car glove compartment, was carefully indexed and laid out to
provide readily accessible information and was useful as a checklist whilst
on a job but also easily readable during down time or for exam revision.
The first edition proved extremely popular and successful. However, in
the intervening years pre- hospital care has developed rapidly. Pre-hospital
emergency medicine has become a recognized medical sub-specialty and
the number of universities offering degree courses in Paramedic Science has
increased massively as a bachelor’s degree is now the minimum academic
qualification to become a paramedic. All UK ambulance services are actively
recruiting paramedics and the popularity of developing a portfolio career
encompassing a career in frontline ambulance services along with one in pri-
mary care and emergency care settings has increased. Hence, the need to
update this volume to reflect the breadth of emergency care now practiced
by a greater number of staff in a rapidly changing environment.
This second edition is a complete revision with a much greater focus on
medical emergencies. This reflects the pre-hospital care workload, where
major trauma is uncommon and major medical emergencies may benefit
from early recognition and treatment and many more patients can be man-
aged within a primary care setting and closer to home. However, the ac-
cessibility of the book and its contents remain unchanged, meaning that it
will still provide easily available, pragmatic, and up-to-date advice on the
cases presenting to pre-hospital emergency care providers, whatever their
background.
Fionna Moore
Medical Director
South East Coast Ambulance Service NHS FT
July 2020
vii
Preface to the second
edition
When the first edition of this book was published in 2007, this section was
called Why Bother? and was an explanation of why we, as editors, passion-
ately believed in the value of pre-hospital practice. In 2007, pre-hospital
medicine in the UK was in a very different position to 2020. In a single
decade, the practice of pre-hospital medicine and its place in clinical care
have been transformed. Pre-hospital medicine is now a GMC-recognized
sub-specialty with its own formal training programme, every area of the UK
is covered by its own air-ambulance, and many such services are manned
by doctors as well as dedicated specialist paramedics. Retrieval and transfer
medicine now has its own qualification and both it and pre-hospital medi-
cine more broadly are attracting increasing numbers of enthusiastic practi-
tioners, largely from acute hospital specialties. In addition, established major
trauma systems recognize pre-hospital interventions as an essential compo-
nent of optimal care. Pre-hospital care is becoming increasingly profession-
alized, less the province of ad hoc practitioners, more hospital based, less
primary care focused. As there is an increasing emphasis amongst planners
on emergency department attendance and admission avoidance, the role of
pre-hospital care, for example in the form of rapid response cars, is likely
to increase further.
We were delighted when this small book rapidly established itself as a
popular resource for PHEM practitioners, and we have made every effort
to reflect current practice in this new edition. In a number of cases we
have included techniques which have yet to establish themselves in clin-
ical practice but which we believe are likely to form part of routine clinical
practice in the future or are currently being assessed. We have tried to
offer didactic guidelines which are safe and effective, but we recognize that
individual practitioners’ personal practice may be different. In all cases, prac-
titioners must work within the limits of their own experience and training
and in accordance with the standard procedures of the organizations for
which they work.
IG/KP
North Yorkshire 2020
viii
viii
Acknowledgements
This volume covers a very large area of medical practice and we have done
everything we can to ensure that the material it contains is accurate and up
to date. We are immensely grateful to the individuals listed below who have
been kind enough to read the various chapters and sections, answer ques-
tions and give us the benefit of their expert comments, or have allowed us
to quote from their work:
Professor Richard Bellamy, Dr David Balthazar, Lieutenant Colonel Tony
Calder RAMC, Robert Cole, Dr Paul Hunt, Dan Jafferji, Dr Simon LeClerc,
Dr Caroline Leach, Erica Ley, Debbie Lockwood, Dr Jessica Martin, Dr
Peter Oakley, Dr Gavin Perkins, Sue Putman, Amanda Pye, Dr Paul Reavley,
Dr Alex Scott, Alan Weir, and Dr Owen Williams.
We are especially grateful to Dr Owen Williams for painstakingly
checking the final text for errors. Needless to say, any remaining errors are
entirely our responsibility.
IG/KP
North Yorkshire 2019
ix
Contents
Foreword v
Foreword vi
Preface to the second edition vii
Acknowledgements viii
Abbreviations xi
1 An approach to pre- hospital care 1
2 Acute medical and surgical problems 53
3 Trauma 151
4 Formulary 283
5 Management of the airway, analgesia,
and anaesthesia 343
6 Poisoning 369
7 Acute psychiatric emergencies 459
8 Child health 473
9 The hostile environment 539
10 Major incident management and triage 563
11 Chemical, biological, radiological,
and nuclear incidents 615
12 Emergency obstetrics, gynaecology, and care of
the newborn 659
13 Patient rescue and transportation 699
Index 723