Reappraising the prehospital care of the patient with major trauma

Recent research efforts have demonstrated that many long-standing practices for the prehospital resuscitation of trauma patients may be inappropriate, particularly in certain circumstances. Traditional practices, such as application of antishock garments and IV fluid administration, may even be detrimental in certain patients with uncontrolled bleeding. Endotracheal intubation, although potentially capable of prolonging a patient's ability to tolerate circulatory arrest, may be harmful if overzealous ventilation further compromises cardiac output in such severe hemodynamic instability. If these procedures delay patient transport, any benefit they may offer could be outweighed by delaying definitive care. To improve current systems of trauma care, future trauma research must address the different mechanisms of injury, the anatomic areas involved, and the physiologic staging in a given patient.