Opinions expressed in the Correspondence section are those of the authors, and not necessarily of the editors, ACER or SAEM. The editor reserves the right to edit and publish letters as space permits. Letters not meeting submission criteria will not be considered for publication. See "Instructions for Authors."

CORRESPONDENCE A t t e n t i o n to Prehospital C a r e To the Editor: [ f o u n d t h e article " E v a l u a t i o n of EMS M a n a g e m e n t Training Offered During Emergency M e d i c i n e Residency Training" by Valenzuela et al [August 1989;18:812-814] of e x t r e m e interest, especially w h e n juxtaposed to the article's 1984 quote, " w i t h o u t question, EMS is a h e a l t h care a c t i v i t y in the u n i q u e d o m a i n of the e m e r g e n c y p h y s i cian."l

Robert J Rothstein, MD, FACEP -- Section Editor Bethesda, Maryland

T h e concept that some emergency m e d i c i n e residency programs offer little or no education in t h e nine studied EMS areas is surprising. In searching for an explanation, I recalled that there was b u t one question regarding prehospital care (other than disaster management) on the w r i t t e n

ABEM examination, and no questions at all on the oral e x a m i n a t i o n dealing w i t h prehospital care or requiring interaction w i t h p r e h o s p i t a l providers. T h a t was in m a r k e d c o n t r a d i s t i n c t i o n to t h e A m e r i c a n Board of O r t h o p e d i c Surgery w r i t t e n and oral e x a m i n a t i o n s that I took a l m o s t a decade ago. T h e recent increase in a t t e n t i o n in prehospital care is gratifying to those of us w h o were c o m m i t t e d to developing EMS systems and to i m p r o v i n g prehospital care in the 1970s; however, m a k i n g any field of m e d i c i n e a unique d o m a i n requires, at the very least, rigorous education and established competence. Alexander Kuehl, MD, M P H The N e w York Hospital N e w York

1. American College of Emergency Physicians: Categorization of emergency services. Ann Emerg Med 1984;13:546.

S o m e V i e w s on P o s t - T r a u m a t i c N e c k Pain To the Editor: W i t h r e f e r e n c e to t h e a r t i c l e " P o s t - T r a u m a t i c N e c k Pain: A P r o s p e c t i v e and F o l l o w - U p S t u d y " [September 1988;17:906-911], we offer the following c o m m e n t s . It is suggested t h a t the only purpose of performing cervical radiographs in a sizeable n u m b e r of patients w i t h post-traum a t i c n e c k pain is for medic01egal reasons. T h e prognostic value of pre-existing degenerative spondylosis 1 and a sharp reversal of the n o r m a l cervical lordosis 2 in selecting a group of p a t i e n t s w i t h a poor o u t l o o k h a s p r e v i o u s l y been established. As a c c i d e n t and e m e r g e n c y p h y s i c i a n s are b e c o m i n g m o r e involved in the early m a n a g e m e n t of such patients, t h e y need every possible early prognostic clue to facilitate their choosing patients w i t h a bad prognosis for early intensive t r e a t m e n t . Early m o b i l i z a t i o n using the M a i t l a n d t e c h n i q u e has been shown to be effective, 3 but on financial grounds it is impossible to provide this service to all p a t i e n t s w i t h p o s t - t r a u m a t i c n e c k pain. A n y simple test t h a t helps establish a group of patients l i k e l y to have persistent s y m p t o m s is worthwhile, as this group of patients c a n t h e n be r a t i o n a l l y a l l o c a t e d a l i m i t e d r e s o u r c e p h y s i o t h e r a p y treatment. G i v e n t h e great i n v e s t m e n t in t i m e and services expended on patients w i t h p o s t - t r a u m a t i c n e c k pain, it is i m p o r t a n t t h a t the doctors dealing w i t h s u c h cases are convinced t h a t there is an underlying organic basis for the syndrome. T h e best proof of the organic basis for sympt o m s is their persistence after litigation has been settled. G o t t e n 4 found that 12% of patients still had severe sympt o m s after s e t t l e m e n t . M c N a b s found t h a t 45% of patients still had some n e c k s y m p t o m s t w o years after set19:1 January 1990

d e m e n t , w h i l e M o h l 2 found t h a t 43% had some n e c k pain five years after t h e i r s e t t l e m e n t . C e r t a i n l y radiographs have a l i m i t e d ability to demonstrate soft tissue damage, but they still have some prognostic usefulness. Hopefully, m a g n e t i c resonance imaging will provide a greater a m o u n t of useful information. Controlled trials of transelectrical nervous s t i m u l a t i o n to reduce pain perception, pulsed e l e c t r o m a g n e t i c therapy to facilitate soft tissue healing, and a c o m b i n a t i o n of the two m o d a l i t i e s seem i n d i c a t e d to d e t e r m i n e if the prognosis for p o s t - t r a u m a t i c n e c k pain can be improved. Darragy Foley-Nolan, MRCPI, M B Physical Medicine ancl Rehabilitation Peter O'Connor, FRCPI, M D Trauma and Emergency Medicine Mater Misericordiae Hospital Dublin, Ireland

1. Norris SH, Watt J: The prognosis of neck injuries resulting from rearend vehicle collisions. J Bone Joint Surg [Br] 1983;65B:608-611. 2. Mohl M: Soft-tissue injuries of the neck in automobile accidents, factors influencing prognosis, l Bone Joint Surg [Am] 1974;56A:1675q682. 3. MealyM, Brennan H, Courtney G: Early mobilisation of acute whiplash injuries. Br Med J 1986;292:656-657. 4. Gotten N: Survey of one hundred cases of whiplash injury after settlement of litigation. JAMA 1956;162:865-867. 5. McNab J: The "whiplash syndrome." Orthop Clin North Am 1971~2: 389-403.

Annals of Emergency Medicine

105/163

Attention to prehospital care.

Opinions expressed in the Correspondence section are those of the authors, and not necessarily of the editors, ACER or SAEM. The editor reserves the r...
111KB Sizes 0 Downloads 0 Views