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Scenario:
A 22 year old motorcyclist is hit by an oncoming lorry on the 'national highway'. He is making 'gurgling' noises, tachypnoeic and tachycardic, He has a very deformed right arm and right leg. His radial pulse is weak but palpable. He is withdrawing to pain. The nearest facility for poly-trauma is approximately 80 minutes away (if the roads are clear!!!)

What kind of pre-hospital care/system should we have to ensure optimum treatment for this patient?
Do you feel a doctor should be sent out as part of the EMS team?
Is it better just to 'scoop and run' to the nearest health facility for initial stabilisation and then subsequently transfer to another centre for definitive care?
Would you deploy a helicopter to retrieve the patient?
I am sure there are hundreds of other options.... but what is ideal and still feasible?

(sorry ...too many questions!!!)

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My first reply to Maroju is that if the given scenario happened in India,the unfortunate man will die at the site of accident.
To give a more optimistic opinion,taking him to the nearest hospital is probably the only thing to do.Sending an EMS doctor is not practical-I feel.Apart from the medical help there are things the public can do,like helping to take him to hospital.Unfortunately that also does not happen in our side of the world as people are afraid of the legal issues involved.Bobby

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With the current status, this victim has no chance of survival.

The ideal scenario would be a highway ambulance with an emergency medical technician (paramedic) who should intubate this victim, start IV fluids and bring him to the nearest trauma centre. Or call the helicopter after initial stabilization.

I know this will happen in the near future.

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It is reassuring to see that others also feel the same way regarding the current pre-hospital system. I thought I was the only cynical person!!!

From some of the other responses, i felt that we could really kick out some lively debates... hence created more threads under the 'EMS' forum'!!! Please do chip in with your take on these issues....

However, I feel, there is one important area that Bobby Cherian touched on and is quiet important...ie PUBLIC.

What are your 'expectations' from a lay-person in such a scenario? What can public as a group do at the scene to help the patient get good treatment?

What are the implications if they put him on any mode of transport and take him to the nearest health facility?

Is he/she bound by any law to be committal or not in such a situation?

I feel that if that person is not trained in any 'first-aid', basic life support etc, it is good enough for him to summon help and be with the patient comforting him. An untrained person moving the patient may not be ideal (unless it is unsafe for the patient and our 'Good Sam' in that incident site!!!)...

I also feel that it should be a matter of public interest to create awareness of immediacy in such situations. Encouraging discipline and 'roadside manners' would probably be the starting point (simple things like giving way to 'blue-light' ambulances or emergency service vehicles).