DOES THE ACCIDENT PATIENT NEED TO BE PROT ECTED FROM THE EMERGENCY DOCTOR

Quality control in preclinical medical care has become a matter of con cern in recent years. In order to evaluate the quality of treatment on e has to set standards. Most of the current standards were defined by different preclinical care organisations and are also accepted in the unique emergency medical care protocol used in the Federal Republic of Germany. Considering these standards, we retrospectively analyzed the preclinical treatment of all multiple trauma patients admitted to our department between 1985 and 1996. The major issues of this analysis w ere the diagnoses, the indications for invasive measures and the perfo rmance. Regarding the triage, far example, it was noted that 28% of pa tients who should have been admitted to a level I trauma center consid ering the severity of their injury were first admitted to a level III hospital and needed to be transferred later. In 7% of patients two add itional mistakes and in 4% of patients more than two mistakes in the t riage were noted. On the other hand, there are records of patients who were considered to be only slightly injured but received invasive tre atment. Preclinical intubation and mechanical ventilation was not perf ormed in 16.5 % although the severity of injury clearly demanded it. A thoracic drain tube was not positioned in 38 % of patients suffering from severe thoracic trauma (AIS(Thorax) greater than or equal to 4). Insufficient application of resuscitation volume (< 2500 mi on admissi on) was evident in 17 % of all documented patients. According to our r esults, the initial evaluation of severity of injury is still a major problem and leads to wrong decisions for treatment. Although the quali fication of ambulance physicians has been standardized for some years, there are still clear deficits in the preclinical management of traum a patients that need to be targeted.