RESOLVING THE CASUALTY EVACUATION CONFLICT

One of the most contentious issues surrounding the prehospital managem ent of the injured is the decision to stabilize on site or to rapidly evacuate the patient. Although there are vociferous proponents for bot h views, there appears to be little thought given to the rationalizati on of these decisions, and the subject has only merited lip-service in previous texts. Treatment choices and decisions in the prehospital en vironment are notoriously difficult to make. The doctor, unlike ambula nce paramedics, does not necessarily work to didactic protocols and, i f suitably trained, is at liberty to commence advanced resuscitation p rocedures at the roadside. However, these may be time consuming and, t o be of greatest benefit to the patient, fine balance between resuscit ation and evacuation must be drawn. This paper aims to discuss some of the key issues which need to be considered in the prehospital scenari o, such as treatment triage, evacuation priorities, mode of transporta tion and hospital destination. The end result must be to eliminate the medical 'bottleneck' and to afford early and appropriate definitive c are to those in most need.