Prehospital and interhospital transport of the trauma patient

Early care of the injured begins in the prehospital phase, both at the scene and during transport. Urgent transport is predicated in cases in which bleeding cannot be controlled or in which internal, uncontrolled hemorrhage cannot be reasonably excluded. Otherwise, meticulous skeletal immobilization and splinting and aggressive airway management are the basic tenets of out-of-hospital trauma care. Management strategies should take into consideration both anatomic site and mechanism of injury. The value of many prehospital hemorrhagic shock interventions have yet to be proven and these are currently under study, including anti-shock garments, certain intravascular fluid infusions, and even basic cardiopulmonary resuscitation (CPR). In serious head injury, provision of adequate lung inflation (preferably by endotracheal tube) supersedes most other considerations, including attempts at therapeutic hyperventilation. Whatever considerations or therapeutic interventions are used, they must be under strict, knowledgeable medical supervision. Principles of interhospital transports remain essentially the same but should also involve knowledgeable use of appropriate advanced monitoring devices. Both prehospital and interhospital transports are best effected by prospective planning, training, and medical consensus guidelines.