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Accident ‘flying squad’
Abstracts injuries, with the exception of burns, are common after a road traffic accident, and even burns are now occurring more frequently. This striking difference of distribution in the pattern of injuries on the road compared with the racing track is probably due to several factors: 1. The very stringent precautions against fire in the design of motor racing cars and the wearing by all drivers of fire-resistant clothing. 2. The wearing of a safety harness with a driving seat firmly anchored to the floor. 3. The new ' f l o w e r - p o t ' crash helmet which protects not only the cranium but also the mandible and reduces the risk of facial injuries. 4. The safety harness and the compulsory fitting of roll-over bars to protect the driver from multiple injuries should the car turn over. 5. Head injuries are reduced by crash helments. 6. Frontal impact speeds in motor racing in excess of 80 m.p.h, are rare--and racing cars do not collide with heavy goods vehicles nor are they driven in fog. This is an excellent practical article, well worth study in the original. NANCEKEVlLL, D. G. (1972), 'Rescue and treatment of the injured motor-racing driver,' Br. J. Hosp. Med., 7, 593.
British ambulance design The unsatisfactory features of British ambulances are considered and recommendations are made about general design, lighting, heating, reducing noise, identification, and avoiding delay at traffic lights by a device that is carried in the vehicle and will cause lights to change in its favour as it approaches. The author describes his studies of the quality of the ride and gives accounts of ways in which the patient's condition and the crew's performance can be adversely affected by a bumpy ride. Some progress has been made in reducing these disadvantages but the results are not yet commercially available. SNOOK,R. (1972), ' Medical aspects of ambulance design ', Br. med. J., 3, 575.
A c c i d e n t "flying squad' Dr. Snook reports his experiences in response to 132 emergency calls and the steps he took to maximize the value of his attendance. Because he worked in a hospital to which the casualties were taken, he was able to state confidently that 6 lives were certainly and 4 quite likely saved by medical attendance. Successful intervention requires a quick getaway, unimpeded passage, and good communications between doctor, ambulance crew, and their headquarters and hospital, as well as knowledge and equipment. On average, emergency calls occurred every 9½ days, occupied 22 minutes a week in response and another 43 minutes on maintenance and cleaning. Threequarters of the calls were made when he was not on duty at the hospital. Active medical treatment was provided in 22 of 99 calls in which he was in time to
91 deal with more than trivial injuries. Suction and oxygen were used more than any other treatment. The value of Entonox and inflatable splints was confirmed. The special value of this report is that it is a precise account of what was done and, even more important, with what effect. The methods used are described in detail, as is the equipment, which weighs 23 kg. and costs over £900 (over £600 was for the radiotelephone and cardiac monitor). It will long remain an authoritative source of advice for anyone wishing to set up a similar service, which Dr. Snook regards as a natural part of the accident services of a particular area. SNOOK, R. (1972), 'Accident flying squad', Br. med. J., 3, 569.
THORACIC INJURIES
AND
ABDOMINAL
Tracheal reconstruction using an autogenous mucochondrial graft A 24-year-old man who had been treated by emergency tracheotomy following a car accident presented later with tracheal stenosis and with considerable loss of the tracheal wall. Early attempts at repair were unsuccessful and only added to the problem of closure. The defect was finally closed by a local flap of skin and soft tissue into which had been inserted a large mucochondrial graft taken from the nasal septum. The latter graft provided not only the necessary cartilaginous support, but the mucosal cover to reline the trachea. This is a very well illustrated and important case report which deserves careful study in the original text. KRIZEK, T. J., and KIRCHNER, J. A. (1972), ' Tracheal reconstruction with an autogenous mucochondrial graft ', Plastic reconstr. Surg., 50, 123.
Perforating injuries o f the colon A survey of treatment carried out and results achieved in a series of nearly 150. Bad prognostic signs were considered to be faecal contamination, involvement of other organs, local haematoma, and shock. The choice between various procedures including primary suture, exteriorization, proximal decompression, resection and anastomosis, and end colostomy with closure of distal stump is discussed. Leaving the skin incision for secondary healing is recommended. SCHROCK, T. R. (1972), 'Management of perforating injuries of the colon ', Surgery Gynec. Obstet., 135, 65.
Measuring pulmonary compliance A simple technique is described for measuring pulmonary compliance in patients on mechanical respirators. This would, of course, include thoracic injuries. As~ a bedside technique it could form a useful guide to treatment. FLEMING, W. H., BOWEN, J. C., and PETTY, C. (1972), ' The use of pulmonary compliance as a guide
British ambulance design The unsatisfactory features of British ambulances are considered and recommendations are made about general design, lighting, heating, reducing noise, identification, and avoiding delay at traffic lights by a device that is carried in the vehicle and will cause lights to change in its favour as it approaches. The author describes his studies of the quality of the ride and gives accounts of ways in which the patient's condition and the crew's performance can be adversely affected by a bumpy ride. Some progress has been made in reducing these disadvantages but the results are not yet commercially available. SNOOK,R. (1972), ' Medical aspects of ambulance design ', Br. med. J., 3, 575.
A c c i d e n t "flying squad' Dr. Snook reports his experiences in response to 132 emergency calls and the steps he took to maximize the value of his attendance. Because he worked in a hospital to which the casualties were taken, he was able to state confidently that 6 lives were certainly and 4 quite likely saved by medical attendance. Successful intervention requires a quick getaway, unimpeded passage, and good communications between doctor, ambulance crew, and their headquarters and hospital, as well as knowledge and equipment. On average, emergency calls occurred every 9½ days, occupied 22 minutes a week in response and another 43 minutes on maintenance and cleaning. Threequarters of the calls were made when he was not on duty at the hospital. Active medical treatment was provided in 22 of 99 calls in which he was in time to
91 deal with more than trivial injuries. Suction and oxygen were used more than any other treatment. The value of Entonox and inflatable splints was confirmed. The special value of this report is that it is a precise account of what was done and, even more important, with what effect. The methods used are described in detail, as is the equipment, which weighs 23 kg. and costs over £900 (over £600 was for the radiotelephone and cardiac monitor). It will long remain an authoritative source of advice for anyone wishing to set up a similar service, which Dr. Snook regards as a natural part of the accident services of a particular area. SNOOK, R. (1972), 'Accident flying squad', Br. med. J., 3, 569.
THORACIC INJURIES
AND
ABDOMINAL
Tracheal reconstruction using an autogenous mucochondrial graft A 24-year-old man who had been treated by emergency tracheotomy following a car accident presented later with tracheal stenosis and with considerable loss of the tracheal wall. Early attempts at repair were unsuccessful and only added to the problem of closure. The defect was finally closed by a local flap of skin and soft tissue into which had been inserted a large mucochondrial graft taken from the nasal septum. The latter graft provided not only the necessary cartilaginous support, but the mucosal cover to reline the trachea. This is a very well illustrated and important case report which deserves careful study in the original text. KRIZEK, T. J., and KIRCHNER, J. A. (1972), ' Tracheal reconstruction with an autogenous mucochondrial graft ', Plastic reconstr. Surg., 50, 123.
Perforating injuries o f the colon A survey of treatment carried out and results achieved in a series of nearly 150. Bad prognostic signs were considered to be faecal contamination, involvement of other organs, local haematoma, and shock. The choice between various procedures including primary suture, exteriorization, proximal decompression, resection and anastomosis, and end colostomy with closure of distal stump is discussed. Leaving the skin incision for secondary healing is recommended. SCHROCK, T. R. (1972), 'Management of perforating injuries of the colon ', Surgery Gynec. Obstet., 135, 65.
Measuring pulmonary compliance A simple technique is described for measuring pulmonary compliance in patients on mechanical respirators. This would, of course, include thoracic injuries. As~ a bedside technique it could form a useful guide to treatment. FLEMING, W. H., BOWEN, J. C., and PETTY, C. (1972), ' The use of pulmonary compliance as a guide