From the Guidelines
Improvised medicine in prehospital settings should prioritize simple, reproducible, and well-practised techniques to secure the patient's airway, breathing, and circulation, with a focus on minimizing cardiorespiratory compromise, as emphasized by the Association of Anaesthetists of Great Britain and Ireland in 2017 1. The key principles of improvised medicine in prehospital settings involve:
- Focusing on the ABCs (airway, breathing, and circulation) using available materials
- Using manual maneuvers or makeshift adjuncts for airway management
- Employing improvised chest seals and tourniquets for breathing and circulation support
- Prioritizing temperature management and wound care with available resources
- Implementing effective pain management strategies without relying on medications
- Ensuring clear communication and documentation of interventions for receiving facilities These principles are crucial in prehospital settings, as they enable healthcare providers to address immediate life threats and stabilize the patient until definitive care can be provided, as highlighted in the guidelines for safer pre-hospital anaesthesia 1. The balance between optimizing the patient's clinical condition before transfer and minimizing pre-hospital time is critical, and healthcare providers must weigh the benefits of interventions against the need for prompt transport to a hospital, as noted in the 2017 Association of Anaesthetists of Great Britain and Ireland guidelines 1. Effective improvised medicine in prehospital settings requires adaptability, resourcefulness, and a focus on life-saving interventions, ultimately aiming to bridge the gap until hospital care can be accessed, as supported by the principles outlined in the safer pre-hospital anaesthesia guidelines 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Key Principles of Improvised Medicine in Prehospital Settings
The key principles of improvised medicine in prehospital settings can be summarized as follows:
- The administration of tranexamic acid (TXA) in prehospital settings is being practiced, but there is insufficient evidence to support or refute its use 2
- Prehospital time may not be a significant factor in the survival of major trauma patients, but the quality of care received during this time is crucial 3
- The top research priorities in physician-provided pre-hospital critical care include appropriate staffing and training, advanced airway management, definition of time windows for key critical interventions, the role of pre-hospital ultrasound, and dispatch criteria for pre-hospital critical care services 4
- Prehospital interventions should be evidence-based and consider the differences in emergency medical services personnel training, frequencies of exposure to patients, and availabilities of effective continuing education programs in urban and nonurban environments 5
- The need for pre-hospital and emergency care in developing countries is increasing due to epidemiological transitions in disease patterns, and there is a need for organized emergency services to meet these growing needs 6
Improvisation in Prehospital Care
Improvisation in prehospital care may be necessary due to limited resources or lack of specialized equipment. However, it is essential to ensure that any improvisation is based on the best available evidence and does not compromise patient care. The use of tranexamic acid in prehospital settings, for example, is being practiced, but its effectiveness is still being studied 2.
Evidence-Based Practice
Evidence-based practice is crucial in prehospital care to ensure that patients receive the best possible care. This includes the use of evidence-based guidelines, protocols, and interventions. The top research priorities in physician-provided pre-hospital critical care, as identified by a European expert panel, can inform evidence-based practice in this field 4.
Limitations and Future Directions
There are limitations to the current evidence on improvised medicine in prehospital settings. Further research is needed to address these gaps and inform evidence-based practice. The studies cited in this response highlight the need for continued research and development of guidelines and protocols for prehospital care 2, 3, 4, 5, 6.