Debate continues over a ‘scoop and go’ versus a ‘stay and stabilise’ approach to patient care in the prehospital trauma setting. Analysis of data from more than 19 000 patients presenting to a level 1 trauma centre in California revealed increased odds of mortality if the scene time was greater than 20 min in the case of penetrating trauma. Interestingly, this association was not demonstrated amongst patients who had sustained blunt trauma (Ann Emerg Med 2013;61:167–74).

There is evidence to suggest that the risk of road traffic collisions is up to 13 times higher for emergency ambulances per mile travelled than other vehicles. Researchers from Turkey reviewed forensic records and identified 21 deaths of patients who were injured in a road traffic collision whilst being transported in an emergency ambulance (J Forensic Leg Med 2012;19:474–9). Their report is a grim reminder of the...

Preceded by several days of slightly fevered media coverage, the Francis Report was finally published in the first week of February.1 Its breadth is wide, its analysis is forensic in detail, its findings are embarrassing (to put it mildly) and its recommendations (all 290 of them) are game changing. If implemented, Francis will have a bigger impact on the NHS than Kennedy did after Bristol. It makes compelling reading.

Here are a few snippets (from the section listing the inquiry's findings) that are of immediate interest to us:

We had a visit from the Intensive Support Team recently. In common with other Emergency Departments (ED), we have struggled a little to achieve the national 4 h throughput target. The response of our health authority was to send in the IST.

The team, which did not contain an emergency physician, spent about an hour in the department, and of course we were interested to see what they had discovered in an hour which had not been apparent to us over many years. We hoped that their report would recognise that the main causes of our failure to meet the target were the increasing numbers of major cases being brought to the ED, and the inability of our hospital to find accommodation for these patients in a timely fashion.

We were therefore disappointed by the ED section of the report which suggested that senior emergency medicine (EM) physicians should...

A short-cut review of the literature was carried out to establish whether a functional brace was as good as a traditional plaster of Paris to immobilise a stable ankle fracture in terms of functionality and recovery speed. A total of 260 papers was found using the below outlined search method, of which five were thought to represent the best evidence to answer the specific clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these are shown in table 2. The clinical bottom line is that the limited evidence seems to suggest that a functional brace appears to give more favourable outcomes. Good quality studies involving large populations are, however, needed...

To conduct a survey of current alcohol identification and brief advice activity in English Emergency Departments, and to compare the results with the previous survey conducted in 2007.

Cross-sectional survey of all 187 Emergency Departments in England.

Significant increases (p<0.001) in the proportion of departments routinely asking about alcohol, using a screening questionnaire, offering help/advice for alcohol problems, and having access to Alcohol Health Workers or Clinical Nurse Specialists. More than half of all departments indicated that they had an ‘alcohol champion’, and this was significantly associated with access to training on both identification and provision of brief advice (p<0.001). Departments that routinely asked questions were the most likely to use a formal screening tool (p<0.05), and the Paddington Alcohol Test was the most frequently used measure (40.5%).

There have been significant improvements in ED alcohol identification and brief advice activity since 2007 in line with the recommendations of the Royal College of Physicians, Department of Health and NICE guidelines. English EDs are beginning to maximise the likelihood of identifying patients who may benefit from further help or advice about their alcohol consumption, and are able to offer access to specialist staff who can provide appropriate interventions.

To evaluate a new tool to assess emergency physicians' non-technical skills.

This was a multicentre observational study using data collected at four emergency departments in England. A proportion of observations used paired observers to obtain data for inter-rater reliability. Data were also collected for test-retest reliability, observability of skills, mean ratings and dispersion of ratings for each skill, as well as a comparison of skill level between hospitals. Qualitative data described the range of non-technical skills exhibited by trainees and identified sources of rater error.

96 assessments of 43 senior trainees were completed. At a scale level, intra-class coefficients were 0.575, 0.532 and 0.419 and using mean scores were 0.824, 0.702 and 0.519. Spearman's for calculating test-retest reliability was 0.70 using mean scores. All skills were observed more than 60% of the time. The skill Maintenance of Standards received the lowest mean rating (4.8 on a nine-point scale) and the highest mean was calculated for Team Building (6.0). Two skills, Supervision & Feedback and Situational Awareness-Gathering Information, had significantly different distributions of ratings across the four hospitals (p<0.04 and 0.007, respectively), and this appeared to be related to the leadership roles of trainees.

This study shows the performance of the assessment tool is acceptable and provides valuable information to structure the assessment and training of non-technical skills, especially in relation to leadership. The framework of skills may be used to identify areas for development in individual trainees, as well as guide other patient safety interventions.

This study evaluated the feasibility of prehospital tissue oxygen saturation (StO₂) in major trauma patients.

A prospective, pilot feasibility study carried out in a physician based prehospital trauma service.

Prehospital StO₂ was recorded on 13 patients. Continuous StO₂ monitoring was achieved on all patients, despite intermittent failure of pulse oximetry and non-invasive blood pressure monitoring in six patients. No adverse outcomes of StO₂ monitoring were reported. The specific equipment used was reported to be inconveniently bulky and heavy for use in the prehospital setting.

Prehospital measurement and monitoring of StO₂ is feasible in trauma patients undergoing prehospital anaesthesia and may be useful in the early identification of shock, triggering of transfusion protocols and guiding fluid resuscitation.