Emergency Trauma Care While the care of trauma patients is more
controversial than cardiac care for Emergency Medical Services systems, there is
widespread agreement that delivery of critically injured trauma patients to
trauma centers saves lives. Trauma triage protocols are designed to bypass
certain hospitals under predetermined protocols based on the mechanism of injury
or the patient's physiologic status.
There is less agreement on what
therapy should be given by Emergency Medical Services providers to trauma
victims in the field and en route. While the value of providing a secure airway
is unarguable, the value of prehospital intravenous fluid administration has
been challenged.
A study from the Houston EMS system found that for
hypotensive victims of penetrating truncal trauma who required surgical repair,
withholding fluid and blood in both the prehospital and emergency department
phases until arrival in the operating room improved survival rates, reduced the
amount of blood loss, and shortened the overall hospital stay compared with
patients who received fluid and blood in the field and emergency
department.
A case-control study from Pennsylvania for hypotensive blunt
trauma victims found that prehospital fluid administration had no effect on
survival or length of hospital stay. Thus, questions concerning the value of
prehospital fluid therapy for trauma victims remain. Until further studies are
done, emphasis remains on rapid transport and airway support of trauma victims,
with intravenous fluid administration an unproven but commonly performed
treatment.
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