Emergency Care in the New Millenium: Current Developments and Perspectives

In the light of limited finacial resources Emergency Medicine of the new millenium has come under a critical appraisal. As with other medical areas traditional practice patterns are evaluated by evidence based medicine criteria. However, limited human resourses and unique circumstances in the field require any decision to be adapted to the present situation at the scene of an emergency.

By far the most important goal of treatment on scene and transportation is to prevent any further damage in order to achieve a positive clinical outcome in the long run. Traditional strategies of emergency medicine have been “Stay and Play” and “Scoop and Run”. Whilst any life threatening condition requires immediate action any unnecessary or overextended treatment can prolong the on-scene time and thereby delay final in-hospital emergency treatment. Each time the emergency physician in the field has to have an individual strategy that lies somewhere between those traditional strategies. In order to enable the emergency physician to find the “Golden Way” it seams prudent to have standard guidelines based upon scientific data for any procedure in emergency medicine. Effectiveness and efficiency of any of those guidelines ought to be monitored by TQM.

The following articles represent an interesting cross-section of important, frequently encountered problems and special events.

G. Geldner and U. Schwarz describe the ongoing discussion about different concepts in prehospital trauma life support. They conclude that often the importance of short on scene time is underestimated in European EMS.

The new ILCOR guidelines for resuscitation and emergency cardiac care are the topic of C. Kill's article who summarises the latest changes in Basic and Advanced Life Support which anybody involved in Emergency Medicine should be aware of.

H. A. Adams presents pharmacological data on S-Ketamine and refers to its use in Accident & Emergency Medicine. A detailed description of application and dosage for typical preclinical indications can be found in his article.

Th. Luiz et al. report on the pathophysiologic aspects of hypovolemic shock and the mechanisms of small-volume-resuscitation. Although the incidence of severe trauma with progessive hypovolemia has decreased continiously over the past years the authors recommend availability of hypertonic-hyperosmotic solution for the treatment of those cases.

Aspects of medical care as well as rescue strategies of avalanche victims are described by F. Ploner. Hypothermia and the presence of small air pockets are the main prognostic factors for survival. An algorithm for triage and resuscitation of avalanche victims is included.

U. van Laak reviews the dangers and problems of diving. In case of a life threatening incident several specific measures in addition to standard Advanced Life Support must be provided followed by rapid transport to a specialized centre of care in order to achieve the best outcome possible.

With these articles we hope to provide additional information for further discussion of these topics.

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