The equipment used to establish IV access in the field is the same as at the hospital: tourniquets, cleaning agent, IV catheters, IV fluid bags, and IV tubing. In ALS
ambulances, IV access is used for fluid resuscitation and administration of drugs. In general, vascular access is obtained for drug administration as soon as possible after the patient is assessed and it is determined that pharmacologic intervention is required. Paramedics are very adept at rapid IV placement. 11 For fluid resuscitation, usually in trauma patients, vascular access is usually started en route to the hospital after the patient is immobilized, unless there is prolonged scene time due to extrication difficulties. Obtaining IV access should not prolong scene times in a trauma patient, especially when "LOAD AND GO" criteria are present. Prehospital fluid administration may make little difference in the patient's outcome.12 First, the amount of fluid that can be administered during transport in most urban and suburban EMS systems is modest and may not be physiologically significant. Second, there is evidence that prehospital (and emergency department) fluid administration to hypotensive victims of penetrating truncal trauma does not improve survival and may even decrease survival in those patients who require surgery. 13 The medical director is responsible for developing protocols for prehospital IV access and monitoring their use in an ongoing manner.
Vascular access is also utilized by some BLS services, not for drug administration, but for fluid resuscitation. Since BLS services usually serve rural areas and have longer transport times, fluid resuscitation may be more beneficial (although this is unproven) for the hypovolemic trauma patient.
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