Prehospital interventions for trauma: Helpful or harmful? The American point of view

Recent research efforts have shown that many longstanding practices for the prehospital resuscitation of trauma patients may be inappropriate under certain circumstances. For example, traditional practices to elevate systemic blood pressure, such as application of the pneumatic antishock garment and intravenous fluid administration, may even be detrimental to certain patients with uncontrolled bleeding. Although potentially capable of prolonging a patient's ability to tolerate circulatory arrest, even endotracheal intubation may be harmful if overzealous positive-pressure ventilation further compromises cardiac output, particularly in those patients with severe hemodynamic instability. Further studies, including prospective, randominzed clinical trials, are needed to delineate the most appropriate prehospital interventions for trauma care. Furthermore, such research must specifically stratify patients according to the different mechanisms of injury, anatomic areas involved, and physiological staging.