The golden hour and the dull reality. Analysis of traumatic brain injury management in pre-hospital and emergency care.
OBJECTIVE
Continuous progress in medical sciences with simultaneous technological development has created an unavoidable need for a reorganisation of Emergency Health Care in Poland. Introduction of modern means of transport in pre-hospital care, formation of air rescue teams, or standardization of emergency information centres (CPR) play an important role in this reorganisation; however, so far, there is still a lack of coherence between the pre-hospital care and the management within the emergency room.


METHODS
The conducted study was based on an analysis of ambulance service records of 144 patients with severe traumatic brain injury that occurred in 2002-2004, who were in grave clinical status. The study also evaluated duration and distance covered by these patients during the period from the injury to complete surgical management. Relationships between patient's clinical status at admission and discharge, and the duration of pre-hospital and hospital work-up were also analysed.


RESULTS
Despite the existing organisational gaps, outcomes of the therapy of traumatic brain injury patients brought to the hospital by the ambulance directly from the accident scene were by far better than those observed in patients transported from remote lower reference centres, where tie-ups associated with the management process led to significantly longer delays thus resulting in poorer prognosis in these patients.


CONCLUSIONS
According to the analysis the authors conclude that there is a need to reorganise the national system of emergency care in Poland. The most important issues are: to standardize the emergency medical records and initial emergency procedures, to organise multitrauma teams, and to decrease the time of the referral process and definitive care.
Zabek
Mirosław
M
Department of Neurosurgery and Neurotraumatology, Medical Centre for Postgraduate Education (CMKP), Warsaw, Poland. zabek@mds.pl
Zaczyński
Artur
A
D000293:Adolescent; D000328:Adult; D001930:Brain Injuries / Q000628:therapy*; D004632:Emergency Medical Services / Q000458:organization & administration / Q000592:standards*; D004636:Emergency Service, Hospital / Q000458:organization & administration / Q000592:standards; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D011044:Poland; D013597:Systems Analysis; D013997:Time Factors; D014187:Transportation of Patients / Q000458:organization & administration / Q000592:standards; D016896:Treatment Outcome