While the care of trauma patients is more controversial than cardiac care for EMS systems, there is widespread agreement that delivery of critically injured trauma patients to trauma centers saves lives.9 Systems 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 EMS providers to trauma victims in the field and en route. 1 1! Some early literature documented a decreased survival rate if patients received ALS (intravenous fluid administration and intubation) at the scene instead of immediate transport to the hospital; presumably this occurred because of the delay to definitive care. More recent studies have found that paramedics may secure an airway, establish an intravenous line, and infuse significant volumes of fluid rapidly without delaying transport of the patient. While the value of providing a secure airway is unarguable, the value of prehospital intravenous fluid administration has been challenged. Thought-provoking work from Houston 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 to patients who received fluid and blood in the field and emergency department.12 Many 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 the trauma victim, with intravenous fluid administration an unproven but commonly performed treatment.
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