Abstract
Background
Penetrating neck injuries (PNIs) can occur at multiple anatomical sites and involve airway, nerve, vascular and gastrointestinal structures. They pose a unique challenge to clinicians, especially in the pre-hospital setting. Published guidance on the pre-hospital management of PNIs is limited, and there is no review of current pre-hospital practice.
Method
A retrospective electronic case notes review of PNIs managed within one UK Helicopter Emergency Medical Service (HEMS) over a 7-year period was undertaken. Data was collected on zone of injury, mechanism of injury, pre-hospital times, patient demographics, pre-hospital interventions and on-scene mortality.
Results
98 patients met study inclusion criteria, of which 40% had zone II neck injuries. 83% were male with a mean age of 42. The predominant injury mechanism was interpersonal violence (51%), followed by self-harm (47%). 15% underwent pre-hospital emergency anaesthesia, 17% underwent pre-hospital blood transfusion and 30% had a haemostatic dressing applied. No patients underwent cervical spine immobilisation. 1% underwent resuscitative thoracotomy. 5% were pronounced life extinct after HEMS arrival following interventions by the HEMS team.
Conclusion
Time critical and emergent interventions in this select patient population must be minimal and focus on optimizing care during rapid transfer to hospital. Airway and haemorrhagic pathologies must be managed, often concomitantly. Targeted injury prevention to reduce inter-personal violence must ensue. The author group intend to devise a National Delphi and derive consensus guidelines for the management of pre-hospital PNIs.