THE SKY IS A LIMIT - ERRORS IN PREHOSPITAL DIAGNOSIS BY FLIGHT PHYSICIANS

The medical records and air evacuation reports of 186 trauma patients were examined to determine the type and characteristics of missed diag noses. More than 35% of all cases of hypovolemic shock were not identi fied, nor were two cases of respiratory distress. Although unconscious ness was always identified correctly, almost 7% of all cases with part ial unconsciousness were not recorded. Of 443 diagnoses, 337 were corr ectly recorded by the flight physician, slightly more than 76%. The fl ight physicians missed 10 critical diagnoses, all of which were feasib le, 56 important diagnoses, 42 of which were feasible, and 40 relative ly marginal diagnoses, 27 of which were feasible. Injuries to the head , face, and limbs were usually diagnosed correctly and were missed onl y in a few cases, Of considerable clinical relevance was the observati on that flight physicians missed a significant number of critical and important feasible diagnoses of five types: (1) more than half of all feasible diagnoses in the eyes; (2) a third of feasible diagnoses of c ervical spine injuries; and a significant percentage of injuries to th e (3) abdomen, (4) chest, and (5) pelvis. Blunt diagnoses were missed more often than penetrating injuries. Feasible diagnoses were missed i n two of the four cases of paralysis, approximately one third of all c rush injuries, and one quarter of all fractures. This study illuminate s preventable errors of physicians during air evacuation and indicates particular types of serious, feasible diagnoses that flight physician s are prone to miss. Medicine in the sky may pose limits to our diagno stic abilities but the limits could be pushed further. Copyright (C) 1 997 by W.B. Saunders Company.