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Prehospital trauma care
  1. H R Guly
  1. Derriford Hospital, Plymouth, PL6 8DH, UK

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    E Søreide, C M Grande, editors. (Pp 806; $195). Marcel Dekker, 2001. ISBN 0-8247-0537-8.

    There are many unanswered questions in prehospital trauma care (scoop and run or stay and play?; what is the role of doctors, helicopters or intravenous fluids?) but there are no simple answers and all depends on the problem, the distance from hospital, and the circumstances. This makes decision making difficult for both paramedics and for those who write protocols or guidelines. This book does not give answers but provides up to date evidence on which these decisions can be based.

    With over 70 contributors from 18 different countries this is an important work. It not only covers the usual clinical and epidemiological aspects of trauma including chemical hazards, diving accidents, and snake and poisonous insect bites but has chapters on preventing error, continual quality improvement, and debriefing. Despite its title, much of it will also be useful for those who practice in hospital. As with any multi-author book the quality varies with some chapters well written and full of well referenced facts and others slightly pedestrian. I can particularly recommend chapters on the topical subjects of airway care, shock, and fluids.

    The book is not perfect. Firstly, it would benefit from more editing as there is much repetition. For example, there is one chapter on hypothermia and another on accidental hypothermia and avalanches. The same topic is also covered in a chapter on the entrapped patient and the three chapters give two definitions of hypothermia (35°C and 36°C). Despite the multinational authorship, some of the book is very North American and the chapter on helicopters and descriptions of trauma centres make no mention of research done in the UK. I read the chapter on disasters the evening after doing a MIMMS course and one would not believe they were describing the same scenarios. The chapter is very theoretical and I found it fascinating but longed for descriptions of the problems encountered during real major incidents and how these can be overcome. Is there really any indication for prehospital caesarean section (in cardiac arrest) or prehospital autotransfusion?

    There is much excellent material in the book, even in the chapters I have criticised and if one disagrees with some of the ideas, they will, at least, make you think and that cannot be bad. I would recommend it to all involved in prehospital trauma care.