What is Prehospital care?

What is prehospital care? By definition it is not hospital care. WHilst some regard the ability to deliver hospital based interventions in a prehospital setting as a form of prehospital care this will always be an approximation. Some things simply cannot be done to the same standard .

Put simply its location and resources available that define prehospital care. The location can even be within an hospital. Take for example a patient having an xray in the radiology department. Whilst its technically still within an hospital, the location is not typical for patient care. The resources available for patient care are not the same. The most important resource is often human and this is often the most limiting factor in prehospital care. It is the core to its definition in my opinion . Whilst the location maybe within a hospital the limited resources for that location make it similar to prehospital . An entrapped man with legs pinned in the basement of a hospital filled with smoke from a fire has more problems than the crush injuries to his legs . Prehospital care to him is more than rendering prehospital emergency medicine nor critical care . He needs rescue , environmental protection AS well as emergency medical care . These are all elements of the spectrum of prehospital care .

I think prehospital care as being any care outside of a hospital setting. More often than not it is done to prevent or minimise need for hospital care. IN fact in my opinion the highest form of prehospital care is one that avoids the need for any hospital care.

This may at times be the default situation. For example a medical emergency in remote location like an island or cruise/fishing ship in middle of ocean, a space station, a top of a mountain. In these extreme situations there is no transport to a hospital as an option especially for time critical emergencies. The goal of prehospital care in these situations is not transport. It is keeping the patient alive until help arrives. Or sometimes treating the emergency definitively.

An example of this is an acute shoulder dislocation on a ship in middle of ocean. If the patient is by themselves then reducing the dislocation may be vital for their very survival. If they are with a first responder then if they can reduce the dislocation, the emergency is often definitively resolved. Transport to hospital is not often required if this is achieved. This is the highest form of prehospital care in my opinion

Another example is a home visit by a GP to see a patient with respiratory infection. If treatment can be started by GP and avoid transport to hospital then definitive care can be provided.

It is not a surprise to me that in recent years there has been trials and projects to expand paramedics scope of practice to deal with GP presentations as to me this is still within the spectrum and definition of prehospital care. Its community based care whether it be an emergency or a chronic condition.

The oft regarded image of prehospital care is the critical care stabilisation of a life threatening condition or injury to allow rapid transport to hospital for further intervention. This to me is one end of a spectrum of prehospital care.

A nurse doing community vaccination visits is doing a high form of prehospital care. Preventing illness in a prehospital setting.

For a long time and to this day it has been held that to be good at prehospital care one must be good at hospital care . Increasingly we have come to realise that that is the floor of care but not the ceiling . One doesnt necessarily translate well to the other . Put simply one might be great within 4 airconditioned walls with a big red wall button to press to call for help but this doesnt mean one is great in a ditch on side of a road , raining at 2am with a driver entrapped in a car wreck and complaining of leg & neck pain. The reverse is often more the truth . Being able to work with limited resources , improvise and adapt to changing situation is readily translatable to most if not all health care scenarios in hospital

Often those who have worked for a long time in prehospital , find that adapting to hospital based work is not so difficult ; fewer things surprise you . You are used to odd hours , fatigue and dealing with bad outcomes often beyond your control.

Prehospital care is more an attitude to life ; a state of mind and often done with a perverse pride . The first chapter of Prehospital Trauma Life Support course says “The patients who need us out there did not choose us; We chose to do this prehospital work”

Indeed a work ethic & philosophical maxim to hold true in prehospital care