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Saturday, 14 October, 2000, 23:32 GMT 00:32 UK
Emergency care 'can backfire'
A belief that seriously injured patients should receive medical care as soon as possible has been one of the planks of modern medicine.
However, doctors are now beginning to question whether medical intervention soon after a major injury is necessarily a good thing.
The BBC television series Superhuman, presented by leading fertility expert Lord Robert Winston, examines the notion that the seriously injured body might actually fare better if left to its own devices immediately after an accident.
Trauma teams have historically tried to intervene early and reverse many of the changes that our bodies initiate.
Blood pressure drops, so put in fluids. Injured people tend to cool down, so warm them up.
But many of these interventions are now being questioned as trauma doctors increasingly realise that the things the body does to preserve itself after an injury often have a purpose.
Nowhere has the body's ability to cope with even the most traumatic of injury been so graphically illustrated as in the theatre of war.
During the Vietnam War the use of helicopters allowed injured soldiers to reach medical help within minutes.
In many cases, blood or other fluids were given before the injured were even air-lifted out of the battlefield.
Despite this, many of the injured soldiers did not survive and doctors, such as Professor Jim Ryan, began to wonder whether they were doing more harm than good.
As a surgeon in the Falklands, Professor Ryan worked under very different conditions.
There, night battles and bad weather meant that quick recovery by helicopter was impossible and injured soldiers were often left alone for hours.
In 1982, David Gray, then 18, suffered appalling injuries in a mortar attack at Goose Green.
But, like so many of those who were injured, he somehow survived.
Out in the open and untreated, his body's natural emergency systems were allowed to go into action unhindered.
Professor Ryan, and many other doctors like him, believes that the drop in blood pressure may be one of the body's natural safety measures.
The body responds to bleeding by forming a clot. Clotting forms a plug against the flow of blood and the lower the body's blood pressure, the better the chance that the plug stays in place.
Rushing to readjust the blood pressure and bring it back up to normal, then, could reverse this process.
Professor Ryan said: "I am sure that a number of people this century have actually probably been killed by their treatment.
"I think mother nature has built in a mechanism that is millennia old. We have got to be damn careful that any treatment we devise does not upset that."
As a result of observations like this, the routine of giving fluids to all trauma victims is being re-thought.
Paramedics now often watch and wait before trying to raise blood pressure.
Another crucial factor at work in the Falklands was the freezing cold temperature.
Professor Ryan believes that by slowing down some of the body's processes, the cold can actually help to save trauma victims.
The theory was put into practice by trauma doctor Alistair Wilson when treating Kate Close, who was thrown from her horse on a freezing November day.
Paramedics did not reach her for nearly two hours, by which time she was extremely cold.
Kate had a massive head injury and was rushed to the Royal London Hospital.
Dr Wilson was horrified by the seriousness of her injury but made an extraordinary decision - he decided not to warm her up.
Extensive brain damage often occurs after a head injury, not just because of the original injury but also because injured cells release chemicals that cause nearby uninjured cells to "commit suicide".
Doctors do not fully understand why this happens but they have recently discovered is that if the body temperature drops by just a few degrees, widespread damage does not occur. This is what saved Kate's life.
A policy of minimal intervention also saved the life of Los Angeles worker Guillermo Vasques, who suffered a broken neck, fractured skull and massive internal bleeding following a factory explosion.
Surgeon Dr Demetriades knew that the chances of saving Guillermo's life were slim and that intervention might actually kill his patient, so he decided to do the bare minimum to keep the patient alive.
Ignoring Guillermo's other injuries, the doctors glued his liver together and packed it with gauze.
Instead of then sewing his gaping abdomen back together, they covered his guts with plastic and left his body's own repair mechanisms to do the rest.
Guillermo was left to stabilise for three days before Demetriades and his team removed the plastic cover.
To their relief, his liver was healing properly and the internal bleeding had stopped.
Guillermo's bowels were checked for further injury and finally, after the team reconstructed his abdominal wall with a membrane made from pigs intestines, he was sewn up.
Just three weeks after his accident, Guillermo was out of intensive care and out of danger.
Superhuman is broadcast on BBC One on Sunday 15 October at 21 10 BST/20 10 GMT.
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