Prospective observational study to assess the circulatory status of the patients presenting to resuscitation room in emergency department

Abstract

Background: Circulation forms an integral part of a patient presenting to the emergency department (ED). Appropriate management of critically ill patients being brought to the ED is of paramount importance, and inappropriate resuscitation during prehospital transfer could be fatal. Methodology: This prospective study included all priority 1 and trauma patients arriving to the resuscitation room of our ED between August 2018 and October 2018. Details of prehospital management of the circulatory status in the different types of prehospital transport and methods used were noted. A comparison was done between ambulances and private vehicles and receiving prehospital care with the help of univariate analysis. Results: During the study, we recruited 209 patients which comprised trauma (64.1%) and 67 nontrauma (35.9%) priority 1 patients. There was a male predominance (76.7%). Patients were transported by 108 ambulances (9.6%), private ambulances (26.9%), and private vehicles (car, auto, and other vehicles) (60.3%). Of the 142 trauma patients, 66.1% received hemorrhage control as a part of prehospital management. Of the 39.4% trauma patients transported through an ambulance, hypotension was observed in 3.6%, upon their arrival to the ED. Dead and left against medical advice was seen in 0.5% and 1.9%, respectively, whereas 48.8% were discharged stable from the ED. Conclusion: Ambulances bought in patients with adequate hemorrhage control than other vehicles. With an unstable prehospital management in place, a significant sample of patients arrived at ED with a compromised circulatory status. Our study clearly highlights the glaring deficiency in circulatory status at arrival to ED.