CME : Your SA Journal of CPD - Volume 22, Issue 6, June 2004

Doctors practising in the pre-hospital emergency care area need to have training, equipment and dedication. <br>Collaboration with emergency services is vital. Understanding of ambulance personnel capabilities, protocols and equipment is important. <br>The doctor must develop capacity and skills in command and control, communications, driving and navigation. <br>It is advisable to undergo additional advanced life support courses. <br>The provision, marking, equipping and driving of a response vehicle requires training and experience. <br>Personal protection clothing and equipment are vital. <br>Doctor identification documentation and marking are important. <br>Appropriate and compatible medical and other equipment must be carried. <br>Scene approach, assessment, safety and inter-agency co-operation and collaboration are fundamental.

Keep it simple and safe. <br>Document times, drugs, dosages, route of administration. <br>Consider local, regional, general analgesia. <br>Provide analgesia first, regarding morphine as the 'gold standard' in a loading dose of 0.1 mg/kg intravenously, followed after 5 minutes by aliquots of 1 - 2 mg until adequate pain relief without any sign of respiratory depression. <br>Monitor oxygen saturation. <br>Assess need for sedation - use conservative dose of sedative drug if indicated. <br>Monitor and reassess continuously until satisfied that the patient is comfortable and not compromised in any way.

Children are physiologically and psychologically different from adults. These differences have an effect on the way children react to trauma. Consideration must be given to the structural differences, unique anatomy and physiology when assessing injuries in children. <br>The child has the added task of growth, as well as recovery, and cognisance should be taken of the long-term effects of trauma on the injured child and the family. <br>Children are vulnerable to abuse and a high index of suspicion must be maintained to recognise the child at risk of non-accidental injury.

Triage is the process of ordering patients according to medical priority. <br>The overall objective is to do the most good for the most people. <br>Hospital triage involves identifying and preferentially treating life-threatening conditions. <br>Ambulance triage systems include colour-coded and 'priority- based' systems. <br>There is lack of uniformity and continuity in triage processes in South Africa. <br>No definitive triage physiological or algorithmic scoring system is currently in use. <br>A uniform national ambulance and hospital-based system would facilitate triage and treatment.

Aeromedical transport is no longer a rarity but rather an everyday event. <br>Although initial development was under the auspices of the military a highly successful civilian model has developed. <br>South African medical practitioners often shy away from utilising an aeromedical service due to the perceived high financial cost of such a service. <br>When used appropriately the aircraft can greatly benefit patient care while at the same time costing less than equivalent road transportation. <br>The full range of benefits achieved still needs to be quantified. <br>Appropriate utilisation is based on many parameters, including medical criteria as well as distance. <br>South Africa is a country characterised by long distances. These distances are no longer an obstacle as regards the delivery of emergency medical services.