State of the Art of Fluid Resuscitation 2010: Prehospital and Immediate Transition to the Hospital

Abstract

Abstract : The Prehospital Fluid Conference was sponsored by the US Army Institute of Surgical Research and Combat Casualty Care Research, US Army Medical Research and Materiel Command. Some 65 conferees were invited in January 2010 to review the contemporary guidelines on the use of fluid resuscitation in treating combat casualties, discuss the state of the art of fluid resuscitation for combat casualties, and answer the following questions: - Are current Tactical Combat Casualty Care (TCCC) intravenous (IV) fluid resuscitation guidelines optimal for today? - Which IV fluid should be the top priority for future research? - What are the current indications for fluid resuscitation in the combat trauma patient? - What is the current practice in tactical fluid resuscitation? The objective of this conference was to identify the fluid to be used by the prehospital provider and not to address the needs once definitive hemorrhage control has been achieved. The fluids to be used are those that will be carried into the field on the back of the combat medic or in the vehicle used to transport the medic or the patient (echelon 1 care). There are several definitions of these echelons of care (North Atlantic Treaty Organization [NATO], European forces, etc.). The definitions used in this document are those of the Joint Theater Trauma System. The use of role and echelon can be interchangeable depending on the country of origin, but the terms can vary significantly. Echelon, as used in many/most of Joint Theater Trauma System presentations will be used throughout this document to indicate a level of care facility (see Table 1). Although discussions focused on military needs, it was understood and accepted by the consensus group that many, if not all, of the recommendations could and would be used for civilian prehospital providers with appropriate situational modifications.