Should Emergency Providers be Trained in Performing Decompressive Craniectomy?
Subdural Hematoma and Epidural Hematoma due to trauma warrant urgent surgical decompression to decrease mortality and morbidity associated with secondary damage to brain parenchyma. The time between onset of hemorrhage and its effects allow a very narrow window during which surgical decompression is imperative in order to prevent neurological damage. Transportation from site of accident to hospital usually takes a crucial portion of time, which consequently delays the administration of definitive care. Additionally, the absence of immediate neurosurgical support in ER further delays the management. The standard medical therapy prior to availability of surgical decompression is efficiently carried out by ER physician, however, immediate surgical intervention is still necessary. This raises the question of training ER physician to carry out such procedures efficiently where time is legit money and delay can cost the life of the patient. As emergency provider, one should be equipped with all the essential life-saving skills, including those where surgical intervention is required. EZ-Intraosseous needle has been proved to be a useful tool to tackle condition where temporary management of subdural hematoma and epidural hematoma is required, until definitive care is available. In ideal cases, such techniques should be done by neurosurgeons or under supervision of neurosurgeon. However, in case where no guidance is available, the emergency provider should measure risk vs benefit and may perform the procedure in order to save life. Source Decompression of Subdural Hematomas Using an Intraosseous Needle in the Emergency Department: A Case Series https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7434269/ Image shows IO needle positioned on scalp. Taken from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7434269/
a doctor is forever a student. he keeps on learning new skills everyday. i think it's up to them if they want to equip themselves with new skills. otherwise, the trauma center should ensure presence of such specialists 24/7
I think there are lots of emergency procedures that EMTs should he trained to perform.
