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  1. J P Wyatt1,
  2. A Newton2
  1. 1Department of Accident and Emergency, Royal Cornwall Hospital, Treliske, Truro, Cornwall TR1 3LJ, UK
  2. 2Emergency Department, John Radcliffe Hospital, Oxford OX3 9DU, UK
  1. Correspondence to:
 Mr J P Wyatt;
 jonathan.wyattrcht.cornwall.nhs.uk

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    Prehospital corticosteroids for spinal cord injury ▸

    A position paper from the National Association of EMS Physicians in the US, this article reviews the literature, both human and animal, and concludes that there is no convincing evidence of benefit for the use of high dose corticosteroids in acute spinal cord injury. It also states that there is a significant potential for serious adverse effects. Overall the association recommends that high dose corticosteroids should no longer be used in the prehospital management of spinal cord injuries.

    ▸Bledose BE, Weslet AK, Salomone JP. High-dose steroids for acute spinal cord injury in emergency medical services. Prehosp Emerg Care2004;8:313–16.
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    Prehospital guidelines for brain injuries ▸

    Guidelines for prehospital management of traumatic brain injury have been developed by the Brain Trauma Foundation in the US. These focus on the prevention of secondary brain injury, by maintenance of the airway and oxygenation and maximising brain perfusion. This prospective study evaluated the implementation of these guidelines, assessing the areas of provider education, practice implementation, and patient outcome. Data were collected for five months before a two month educational programme. After the programme, a further five months of data were collected. The results showed a significant increase in knowledge of traumatic brain injury management after education. There was a significant decrease in the prehospital incidence of hypoxia and of those arriving at hospital hypotensive. The 30 day mortality for patients with moderate to severe brain injury fell significantly after implementation and the functional outcome in survivors significantly improved.

    ▸Watts DD, Hanfling D, Waller MA, et al. An evaluation of the use of guidelines in prehospital management of brain injury. Prehosp Emerg Care2004;8:254–61.
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    This multicentred, double blinded intensive case based study compared fluid resuscitation with either 4% albumin or normal saline. A total of almost 7000 patients were recruited from 16 centres during the trial period. The allocated fluid was used for all resuscitation until discharge, death, or up to 28 days. The primary outcome measure of mortality at 28 days was similar in both groups—relative risk of death in the albumin group was 0.99 (95% CI 0.91 to 1.09). Secondary outcome measures of survival time …

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