EMERGENCY TRAUMA CARE

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.