Invasive and surgical procedures in pre-hospital care: what is the need?

I. M. Shapey, D. S. Kumar, K. Roberts

On occasion, advanced invasive procedures in pre-hospital care can be life saving. This study aimed to identify the contemporary use of these procedures on a regional doctor-led air ambulance unit, and to define the need, skill set and training requirements for a regional pre-hospital team in the UK. Mission data were recorded prospectively and the database reviewed to identify invasive procedures over a 76-month period. These cases were reviewed with indications, mechanism of injury, presence of cardiac arrest at any time point (±return of spontaneous circulation) and procedural failure or morbidity. Two hundred and thirty-five procedures were performed: 16 for injuries affecting the airway, 111 for breathing and 108 for circulation. Almost a third of patients in cardiac arrest regained spontaneous circulation. Procedures performed increased fivefold from 2003 to 2009, with a marked increase in the use of thoracostomy and intra-osseous access. Procedural failure or inadequacy was high with needle cricothyroidotomy, needle chest decompression and early intra-osseous access experience. A steady increase in the number of procedures was observed over time. Less invasive methods of airway and breathing support were frequently inadequate, though definitive surgical airway or chest decompression was effective each time it was performed. Thoracotomy was performed infrequently. There are implications for the training of pre-hospital doctors who work in the majority of the UK.