Thursday, November 22, 2007
French vs British Doctors: Scoop and Run or Treat on the Scene
The inquest into Princess Diana's untimely death presents an interesting question: for these sort of highly traumatic injuries, which is the best strategy? British doctors advocate a scoop and run approach, but it took 35 minutes to extricate Diana from the crash. Inside the ambulance Diana was reported to have been semi-conscious; she shouted out, pulled out her drip and had to be otherwise restrained. One presumes she was somehow conscious of her injuries and perhaps panicked, fearing she had been attacked or a target of assassination.
But the French crews kept her in one place until 1:40am before transporting her to the hospital. In the entire period she suffered 2 cardiac arrests, and doctors performed heart massage.
Jean-Marc Martino was reported also to have instructed the ambulance to 'drive slowly'. The vehicle also remained stationery without any activity for around 5 minutes outside the hospital entrance. During this period, the Princess' blood pressure dropped to critical levels.
I am personally an advocate of the 'scoop and run' approach. I was a victim of a car accident and it is a nightmare being 'exposed' and in a non 'safe zone' under those circumstances. Highways and roads are just very nasty, alien, unsafe places to be, and efforts should be made to always evacuate from these bleak locations. Doing everything possible to get the patient to a place where all the necessary facilities exist should be the goal. Applying a minimum set of stabilising procedures (for example stemming the flow of blood, applying stabilising medications)is also recommended.
One Size Cannot Fit All
But I think it is a mistake to apply a 'blanket' approach. Under some scenarios, certainly, a patient can and must be treated in situ. For these cases, the ambulances must necessarily be thoroughly equipped to deal with the maximum of eventualities.
In the case of Princess Diana, a rapid scoop and run with in-transit treatment may have made all the difference. It is easier to make these assessments in retrospect, but if we can learn the valuable lessons there are to learn from them, many more lives can be saved.
This post was based in part on an article published recently in The Times (SA)