Prehospital trauma severity is difficult ▸

A “standby call” from an in-bound ambulance may allow the hospital to prepare space and equipment as well as to alert key staff. On the other hand, an inappropriate call could be considered a waste of recourses. This study compared prehospital alert calls with injury severity derived from the Trauma Audit Research Network (TARN) database. The researchers found that the majority of severely injured patients (injury severity score >15) were not the subject of an alert call. Seventy five per cent of calls were for patients who proved not to have serious injuries. Assessment of severity of trauma in the prehospital setting is clearly difficult, but has the potential to assist hospital management.

Prehospital hypertonic saline of no benefit in hypotensive brain injury ▸

There is continuing interest in the potential value of hypertonic saline in the management of head injury. In this double blind, randomised controlled trial of prehospital fluid resuscitation, hypotensive brain injured patients were treated with hypertonic saline or Ringer’s lactate. The investigators found no significant difference in survival to hospital discharge and crucially no difference in neurological status (as measured by extended Glasgow outcome score) at six months.

Prehospital intubation shows no benefit ▸

Investigators reviewed 316 trauma patients intubated (without drugs) in the prehospital setting, comparing these with 217 patients who received respiratory support by bag-valve-mask ventilation. Mortality was significantly higher in the group who were intubated (88.9% compared with 30.0%), partly reflecting the injury severity scores, revised trauma scores, and mechanisms of injury in this group. However, the authors conclude that tracheal intubation confers no …