Determining the Composition and Benefit of the Pre-Hospital Medical Response Team in the Conflict Setting
- Lt Col Peter Davis, MRCGP FACEM Dip IMC Dip Mtn Med RAMC1⇓,
- AC Rickards, Specialist Registrar 2 and
- JE Ollerton3
- 1Consultant Emergency Medicine, 16 Close Support Medical Regiment
- 2Emergency Medicine Glasgow
- 3Consultant Emergency Medicine, Queens Medical Centre, Nottingham
- Consultant Emergency Medicine, 16 Close Support Medical Regiment, Southern General Hospital, Glasgow G51 4TF
Aim To determine the optimal composition of the pre-hospital medical response team (MERT) and the value of prehospital critical care interventions in a military setting, and specifically to determine both the benefit of including a doctor in the pre-hospital response team and the relevance of the time and distance to definitive care.
Method A comprehensive review of the literature incorporating a range of electronic search engines and hand searches of key journals.
Results There was no level 1 evidence on which to base conclusions. The 15 most relevant articles were analysed in detail. There was one randomized controlled trial (level 2 evidence) that supports the inclusion of a doctor on MERT. Several cohort studies were identified that analysed the benefits of specific critical care interventions in the pre-hospital setting.
Conclusions A doctor with critical care skills deployed on the MERT is associated with improved survival in victims of major trauma. Specific critical care interventions including emergency endotracheal intubation and ventilation, and intercostal drainage are associated with improved survival and functional recovery in certain patients. These benefits appear to be more easily demonstrated for the rural and remote setting than for the urban setting.
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