Prehospital emergency care – Related resources

Cochrane reviews

• Early treatment with tranexamic acid (≤3 hours from injury) reduces mortality in bleeding trauma patients. For trauma patients admitted late after injury, tranexamic acid is less effective and could be harmful .
• Resuscitation with colloids appears not to reduce the risk of death, compared to resuscitation with crystalloids. Furthermore, the use of hydroxyethyl starch appears to increase mortality .
• Advanced trauma life support courses for hospital staff might possibly not be effective in improving patient outcome in trauma patients, but the evidence is insufficient .
Helicopter emergency medical services used to transfer adults with major trauma to higher level trauma centers may be beneficial Helicopter emergency medical services used to transfer adults with major trauma to higher level trauma centers may be beneficial Early treatment with tranexamic acid (≤3 hours from injury) reduces mortality in bleeding trauma patients. For trauma patients admitted late after injury, tranexamic acid is less effective and could be harmful .There is no evidence to support early or larger volume of intravenous fluid administration in uncontrolled haemorrhage. There is continuing uncertainty about the best fluid administration strategy in bleeding trauma patients .
• Albumin administration appears not to reduce mortality in patients with hypovolaemia or in critically ill patients with burns and hypoalbuminaemia .
• There seems to be no evidence of the effectiveness of advanced life support training for ambulance crews on injury mortality or morbidity, although the evidence is insufficient.
• There is no evidence to support a particular vasopressor to be superior to other agents in states of shock .

Other evidence summaries

• Hypertonic saline plus dextran seems to be more effective than hypertonic saline alone for the initial treatment of trauma, although there is no evidence from controlled trials . Life support courses of trauma patients for health care personnel may improve patient outcome .
• In acute blood loss a large postural pulse change (greater or equal to 30 beats per minute) or severe postural dizziness appear to suggest hypovolaemia .

Literature

• Berlac P, Hyldmo PK, Kongstad P, Kurola J, Nakstad AR, Sandberg M, Scandinavian Society for Anesthesiology and Intensive Care Medicine. Pre-hospital airway management: guidelines from a task force from the Scandinavian Society for Anaesthesiology and Intensive Care Medicine. Acta Anaesthesiol Scand 2008 Aug;52(7):897-907.