Are there differences in outcomes between “scoop and run” and “stay and play” pre-hospital care models?

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I was reading the news, and I saw something incredible.  There is, currently, a study underway (November 2016 Maher Editorial) which is looking into whether or not “stay and play” prehospital care changes outcomes compared to “scoop and run”.  This reminded me of a talk Sam Galvagno gave which talked about in Vietnam, injured soldiers who were strapped to the outside of helicopters without IVs and endotracheal tubes, were more likely to survive compared to historical controls.

Maureen McCunn connected me to Dr. Zoe Maher, and she agreed to write a short description giving the background for this study.  Dr. Zoe Maher completed her surgical residency, as well as, her trauma and critical care fellowship at Temple University.  Not only is she invested in training future surgeons, and performing research to improve the care of the traumatically injured, but she is also involved with surgery globally.  Her co-author, Dr. Amy Goldberg is the Chair of Surgery, Surgeon-in-Chief and Medical Director of Perioperative Services at Temple.

I am looking forward to reading everyone’s comments about this study.

What are your thoughts? What do you think this study will show? Tell us now.

 

 

5 Comments on “Are there differences in outcomes between “scoop and run” and “stay and play” pre-hospital care models?”

  1. This is an interesting question and a topic that needs to be studied carefully! Ironically, Anesthesiologists are the ones who really “invented” pre-hospital care – after all, not much surgery is done before the patient reaches the hospital. We should be the ones who train the field providers in what we do best (patient assessment, decision on mode of transport, monitoring throughout transport, airway management, pharmacological therapy, transfusion therapy, IV access……ALL anesthesiology skills!

    Why are the surgeons performing these studies?? Our specialty is the one who can truly make a difference on patient outcomes from the field.

    As trauma anesthesiologists, we ALL need to be educating and training our field providers and start performing pre-hospital research studies where we can make a significant contribution to overall trauma patient care.

  2. I do think it is interesting that we aren’t doing more. At least, I don’t see it being written more by anesthesiologists.

  3. Stay and Play is only useful if you cannot get away or get the patient to a suitable hospital in time without detrimental deterioration .

    The later approach would be “sweep and treat”: do your things on the road/ in the air. There is ample experience from the UK MERT (air ambulance Afghanistan) that for the very seriously injured an enroute dedicated prehospital resuscitation team focused on stopping the bleeding and getting blood products in as early as possible, produced unexpected survivors. The transport, the forward resusc and the multiple operating teams in the receiving hospital achieved higher than expected survivor numbers. The approach in Israel where they train bystanders and taxidrivers to rush to hospital with a casualty, would likely support the scoop and run.
    The distance from the appropriate hospital is a factor as well. If you have to travel several hours a few minutes lost will have less impact.

    I hope the result is: scoop and run is best. I have been preaching ” as fast as possible to the most appropriate hospital (paeds centre, neuro centre trauma centre)” for years now.

    The fact that surgeons do the studies cannot be held against them. Many many studies are done by surgeons rather than anestesiologists and are published in anesthesia journals. The why is for us to answer.

  4. The notion of Scoop and Run vs Stay and Play is an unhelpful one. It’s a familiar rhyme but it misses the point. And I completely agree with Chris’s assessment of the UK RAF MERT as Sweep and Treat. The MERT was (is) anything but scoop and run. It is the definition of aggressive, high intervention pre hospital trauma care – it just performed those interventions in transit with consultant level critical care doctors. Of course it was forced by tactical circumstance to operate in that way. Rarely are civilian teams similarly pressured to evacuate a landing site quite as quickly.

    The questions that many civilian retrieval organisations continue to grapple with however is who should be the ones performing the prehospital interventions and how do they get dispatched fast enough to matter?

    Should it be doctors? paramedics? nurses? a combination? or should all these procedures only be performed in a hospital by a trauma team? What if the distance to a trauma centre is several hours and pre hospital teams are not skilled in life saving interventions because they only scoop and run? Is that an acceptable bad-luck for the remote patient?

    A severely injured patient needs advanced trauma care from the moment they’re injured. If they can get that care rapidly by advanced prehospital teams who bring the resus bay to the roadside and perform procedures of an equivalent standard to in hospital teams prior to transport, then that’s great. If they are around the corner from a trauma centre when they’re injured then leaving them on the scene waiting for a retrieval team is not in the patient’s best interests either.

  5. I have to admit that I am biased. However, I think in the US, the biggest dividing line will be urban versus rural setting. It is hard for me to imagine an urban setting (maybe rush hour?) in the US where scoop and run will not be the better option. I am willing to withhold judgment until the data is out that supports which ever mode of care.

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