This guidance covers the management of adults, children and infants with physical injuries as a result of trauma, in whom there is evidence of obvious or probable blood loss. It does not cover the management of isolated closed head injury. For the purpose of this guidance, it is assumed that basic life support and ongoing assessment of the trauma victim are taking place as appropriate. The requirement for cannulation is considered only within the context of pre-hospital intravenous fluid (IV fluid) administration.
1.1 It is recommended that in the pre-hospital management of adults and older children, IV fluid should not be administered if a radial pulse can be felt (or, for penetrating torso injuries, if a central pulse can be felt).
1.2 In the absence of a radial pulse (or a central pulse for penetrating torso injuries) in adults and older children, it is recommended that IV fluid should be administered in boluses of no more than 250 ml. The patient should then be reassessed, and the process repeated until a radial pulse (or central pulse for penetrating torso injuries) is palpable.
1.3 The administration of IV fluid should not delay transportation to hospital, but when given in accordance with 1.2 above, consideration should be given to administration en route to hospital.
1.4 It is recommended that when IV fluid is indicated in the pre-hospital setting, crystalloid solutions should be the routine choice.
1.5 There is inadequate evidence on which the Institute can base recommendations on when pre-hospital use of IV fluid in young children and infants following trauma is appropriate, or on the volumes of fluid to use. However, there is a broad consensus that transfer to hospital should not be delayed by attempts to administer IV fluid.
1.6 It is recommended that only healthcare professionals who have been appropriately trained in advanced life-support techniques and pre-hospital care should administer IV fluid therapy to trauma patients in the pre-hospital setting.
1.7 Training programmes for healthcare professionals should incorporate the above recommendations.