Pre-hospital initiation of fluid replacement therapy in trauma

NICE technology appraisals [TA74] Published date:

NICE has made the following recommendations about giving IV fluid replacement to injured people before they reach hospital. The guidance applies to adults and older children, but does not apply when the only injury is a head injury with no visible bleeding.

A person who has been injured should not be given IV fluids before reaching hospital if a pulse can be felt at his or her wrist. Checking the wrist pulse (the medical term for this is the radial pulse) is a quick and simple way of assessing whether the blood is circulating round the body. If there is bleeding from a wound on the back, chest or abdomen caused by, for example, a knife or glass, the ambulance crew should check a different pulse – the central pulse, which is felt at the neck. IV fluid should be given if the pulse cannot be felt. The person should receive up to 250 ml of fluid at a time. After each dose, the pulse should be checked, and another dose given if the pulse still cannot be felt.

NICE says that, if IV fluids are given, ambulance staff should consider starting replacement on the way to hospital. Starting fluid replacement should not cause delays in getting the person to hospital. When IV fluids are given before an injured person reaches hospital, crystalloid solutions should usually be used.

NICE says there is not enough evidence for it to be able to make recommendations on giving IV fluids to injured babies and young children before reaching hospital. Most doctors agree that IV fluid replacement should not be started if it will delay getting the child to hospital.

Only staff who have had special training in techniques called advanced life support and pre-hospital care should give IV fluids to injured people before they reach hospital. These staff are usually paramedics or doctors.

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