Fluid Resuscitation in Pre-Hospital Trauma Care: a consensus view.

Fluid administration for trauma in the pre-hospital environment is a challenging and controversial area. There is not yet any equivocal answer which can be supported by clear unanswerable evidence. Nevertheless, a careful reading of what evidence is available does allow some provisional conclusions to be drawn. We believe that the following represent the best possible current expert consensus on pre-hospital fluids in trauma. As future evidence brings clarity to this area, these guidelines can be modified, and further consensus statements will be issued taking into account such information. When treating trauma victims in the pre-hospital arena: Cannulation should take place en route where possible Only two attempts at cannulation should be made Transfer should not be delayed by attempts to obtain intravenous access Entrapped patients require cannulation at the scene Normal saline is recommended as a suitable fluid for administration to trauma patients Boluses of 250 ml fluid may be titrated against the presence or absence of a radial pulse (caveats; penetrating torso injury, head injury, infants).