Emergency Medicine Journal
December 2014, Volume 31, Issue 12
http://emj.bmj.com/content/current

The view from here
Typhoon Haiyan disaster in the Philippines: paediatric field hospital perspectives
Dov Albukrek1,2, Joseph Mendlovic1,2, Tal Marom1,3
Author Affiliations
1Israeli Defense Forces Medical Corps, Tel Hashomer, Israel
2Israel Ministry of Health, Jerusalem, Israel
3Department of Otolaryngology—Head & Neck Surgery, Edith Wolfson Medical Center, Tel Aviv University Sackler School of Medicine, Holon, Israel
Extract
In November 2013, super-typhoon Haiyan made several landfalls in the Philippines archipelago. It was one of the strongest cyclones ever recorded, with gusting winds and giant waves that left enormous damage in its wake: more than 6000 people were killed, almost 28 000 were injured and over four million lost their homes. Most basic infrastructure ceased to function, including electricity and water supplies, transportation and communication. Ten million Filipinos were affected overall.
Our medical task force
Following a formal aid request from the Filipino government, the Israeli Defense Forces (IDF) mobilised a medical response team to the island of Cebu, some 10 000 kms away. Because of the immense destruction, there were many casualties and only a few injured patients alive at the scene, making trauma care less a priority than ambulatory medical services for acute and chronic diseases. Of the 148 IDF mission participants, 56 were medical personnel. Others included logistics, support and rescue personnel from the IDF Home Front Command. Among 24 physicians, there were four paediatricians (including an emergency medicine specialist) and three paediatric nurses. Portable facilities included an imaging unit (portable digital X-ray and ultrasound machines), clinical laboratory (chemistry and haematology analyses, bacterial cultures and virology studies) and a fully supplied pharmacy.
Integrated field hospital
In coordination with the Filipino authorities, we reached our destination of Bogo city, in the northern part of the island of Cebu. We were the first medical task force and the only paediatric multidisciplinary team operating in the area, where most primary clinics were destroyed or closed. Unlike other paediatric field hospitals in disaster areas,1 ,2 we decided to create an integrated paediatric emergency unit (PEU), together with the staff of Bogo district hospital. This 80-bed urban hospital, staffed by four physicians (including one paediatrician) and 15 nurses, had already admitted more than 100 patients by the time of our arrival…

Review
Critical care paramedics: where is the evidence? a systematic review
Johannes von Vopelius-Feldt1, John Wood2, Jonathan Benger1,3
Author Affiliations
1Academic Department of Emergency Care, Emergency Department, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
2South Western Ambulance Service NHS Trust, Bristol, UK
3Faculty of Health and Life Sciences, University of the West of England, Bristol, UK
Abstract
Objectives Paramedic-delivered prehospital critical care is an established concept in a number of emergency medical services around the world and, more recently, has been introduced to the UK. This review identifies and describes the available evidence relating to paramedics who routinely provide prehospital critical care as primary scene response (critical care paramedics, or CCP).
Methods A systematic search of electronic databases was performed: CENTRAL, EMBASE, MEDLINE (through EMBASE and Web of Knowledge) and Web of Science (through Web of Knowledge).
Results The search identified 12 relevant publications, one of which was a randomised controlled trial. The remaining 11 were retrospective studies. Five studies compared CCPs with physician-led care. Three of these publications demonstrated improved outcomes with physician care, while two showed no difference. Four further publications examined CCPs versus non-physician-led care and found improved outcomes (two studies), mixed effects (one study) and no difference (one study) for CCPs. Finally, three publications addressed the addition of skills to CCP competencies. A randomised controlled trial of CCP rapid sequence induction (RSI) and tracheal intubation demonstrated improved neurologic outcomes. CCP tube thoracostomy was shown to have similar complication rates to the same procedure performed in the emergency department, while addition of a non-invasive ventilation protocol to CCP practice had no effect on long-term mortality.
Conclusions There is limited evidence to support the concept of paramedic-delivered prehospital critical care. The best available evidence suggests a benefit from prehospital RSI carried out by CCPs in patients with severe traumatic brain injury, but the impact of CCPs remains unclear for many conditions. Further high-quality research in this area would be welcome.