Pre-Hospital Anesthesia Handbook

224 Pages·2016·4.37 MB·English

by  Tim Lowes

Tim Lowes · Amy Gospel
Andrew Griffiths · Jeremy Henning
Pre-Hospital
Anesthesia Handbook
Second Edition
123
Pre-Hospital Anesthesia
Handbook

Tim Lowes (cid:129) Amy Gospel
Andrew G riffi ths (cid:129) Jeremy Henning
Pre-Hospital Anesthesia
Handbook

Second Edition
Tim Lowes Andrew Griffiths
Intensive Care Unit The York Hospital
James Cook University Hospital Middlesbrough
Middlesbrough UK
UK
Jeremy Henning
Amy Gospel James Cook University Hospital
Tyne and Wear Middlesbrough
UK UK
ISBN 978-3-319-23089-4 ISBN 978-3-319-23090-0 (eBook)
DOI 10.1007/978-3-319-23090-0
Library of Congress Control Number: 2015958249
Springer Cham Heidelberg New York Dordrecht London
© Springer-Verlag London 2016
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Foreword
The dramatic changes in the management of critically ill or
injured patients in the pre-hospital environment that follow
the implementation of lessons learnt in austere distant zones
precede the publication of focused, evidence-based guides
and manuals. This manual is therefore a great step forwards
in training and assessment.
The commitment expressed in the Darzi report (High
Quality Care for All – NHS Next Stage Review Final Report
2008) to provide the best care for all patients does mean that
there will be occasions when primary resuscitation of patients
is followed by a more prolonged transfer to definitive care.
The opportunities to start and continue critical care of seri-
ously ill patients by skilled anesthetists should provide the
same benefits for civilian populations as has been demon-
strated in hostile operations; a clear message from the
Healthcare Commission (2009).
The authors are all experts in both the practical clinical
application and the academic and research aspects of pre-
hospital care. This manual covers the most important aspects
of anesthesia and rightly concentrates on the safe and rapid
establishment of a secure airway as part of the ongoing care
of the patient. The techniques for rapid sequence induction of
anesthesia are discussed and just as importantly so are the
necessary subsequent anesthesia and sedation techniques.
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vi Foreword
T his manual should be essential reading for all involved in
the pre-hospital arena from paramedical to medical staff. It is
a model for others to follow and it is a privilege to be asked
to write this foreword.
Professor David Lockey
Consultant in Intensive Care Medicine
and Anaesthesia, North Bristol NHS Trust
Honorary Professor of Trauma
and Pre-hospital Medicine, Bristol University
Clinical Director, Severn Major Trauma Network
Research and Development Lead,
London’s Air Ambulance, V ice Chairman,
Faculty of Pre-hospital,Royal College
of Surgeons of Edinburgh
Preface to the Second Edition
S ince the publication of the first edition, Pre-Hospital
Emergency Medicine (PHEM) has evolved significantly. In
the UK there are over twenty helicopter-based air ambulance
services and where previously many of these only had para-
medic crews, the majority now deploy with a combined physi-
cian and paramedic crew.
T here are now many Consultants in Anaesthesia or
Emergency Medicine who have a regular air ambulance day
within their job plan. These Consultants are expected to have
at least a 50 % commitment to their base specialty, so at least
700 will be required nationally to support the current ser-
vices. When the first edition was published, PHEM training
was variable and dependent on individuals and local systems.
PHEM has now been formally approved by the UK General
Medical Council (GMC) as a medical sub-specialty of the
existing specialties of Emergency Medicine, Anaesthetics,
Intensive Care and Acute Medicine. Therefore, an increasing
number of the physicians on board will be doctors undertak-
ing formal PHEM training.
A key part of PHEM training is the provision of anaesthe-
sia in the pre-hospital environment. The Great North Air
Ambulance Service (GNAAS) Pre-hospital Anaesthesia
(PHA) 2-day course has continued to receive excellent feed-
back from the many doctors and paramedics who have filled
every course to date. The PHA Handbook covers all aspects
of PHA, and the second edition includes changes in practice
and additional published evidence from the last five years. An
important element in the safe and successful practice of PHA
is Crew Resource Management (CRM) and a whole new
chapter reflects the importance of this.
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viii Preface to the Second Edition
GNAAS continues to be funded by public charitable
donation to provide both aircraft and medical staff. The
authors will continue to donate all royalties from the sale of
this book to the charity fund, specifically in order to improve
the equipment required to maintain the high standard of
training, both on the course and undertaken on a regular
basis by the crew.
Middlesbrough and York, UK Tim Lowes
Amy Gospel
Andy Griffiths
Jeremy Henning
Preface to the First Edition
Over the past few years in the United Kingdom there have
been many reports into trauma which have highlighted poor
pre-hospital care as a major cause of possibly preventable
deaths. Similar issues have been identified internationally.
Many pre-hospital systems have therefore developed stan-
dard operating procedures that involve inducing anesthesia
for airway control.
Many physician providers find it difficult to access training
in this area, and assisting anesthesia is outside most paramed-
ics’ curriculum. This was a problem we faced at the Great
North Air Ambulance Service. To address this, we developed
a two day course to provide an introduction to pre-hospital
anesthetic practice. This book has evolved from the manual
we wrote for the course, which we continue to run three times
a year.
It is clear that pre-hospital anesthesia remains a controver-
sial procedure, with many conflicting papers written about its
benefits and risks. For this reason, anyone undertaking it has
a duty to ensure they undertake it safely and within a well
governed system. A book cannot provide clinical experience,
however, we hope that it will give a good knowledge-base to
guide and develop practice. The available evidence is dis-
cussed, relevant pharmacology is explained and a system to
provide pre-hospital anesthesia is presented.
W e hope this book will prove to be an enjoyable read that
will encourage many to develop their pre-hospital anesthetic
practice. It has to be the hope of all working in this world that
no patient ever dies from having inadequate airway control
before their admission to hospital.
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