Prehospital Care Of Trauma Patients Research Articles

Use of Long Spinal Board Post-Application of Protocol for Spinal Motion Restriction for Spinal Cord Injury.

Historically, prehospital care of trauma patients has included nearly universal use of a cervical collar (C-collar) and long spine board (LSB). Due to recent evidence demonstrating harm in using LSBs, implementation of new spinal motion restriction (SMR) protocols in the prehospital setting should reduce LSB use, even among patients with spinal cord injury. Our goal in this study was to evaluate the rates of and reasons for LSB use in high-risk patients-those with hospital-diagnosed spinal cord injury (SCI)-after statewide implementation of SMR protocols. Applying data from a state emergency medical services (EMS) registry to a state hospital discharge database, we identified cases in which a participating EMS agency provided care for a patient later diagnosed in the hospital with a SCI. Cases were then retrospectively reviewed to determine the prevalence of both LSB and C-collar use before and after agency adoption of a SMR protocol. We reviewed cases with LSB use after SMR protocol implementation to determine the motivations driving continued LSB use. We used simple descriptive statistics, odds ratios (OR) with 95% confidence intervals (CI) to describe the results. We identified 52 EMS agencies in the state of Arizona with 417,979 encounters. There were 225 patients with SCI, of whom 74 were excluded. The LSBs were used in 52 pre-SMR (81%) and 49 post-SMR (56%) cases. The odds of LSB use after SMR protocol implementation was 70% lower than it had been before implementation (OR 0.297, 95% CI 0.139-0.643; P = 0.002). Use of a C-collar after SMR implementation was not significantly changed (OR 0.51, 95% CI 0.23-1.143; P = 0.10). In the 49 cases of LSB use after agency SMR implementation, the most common reasons for LSB placement were ease of lifting (63%), placement by non-transporting agency (18%), and extrication (16.3%). High suspicion of SCI was determined as the primary or secondary reason for not removing LSB after assessment in 63% of those with LSB placement, followed by multiple transfers required (20%), and critical illness (10%). Implementation of selective spinal motion restriction protocols was associated with a statistically significant decrease in the utilization of long spine boards among prehospital patients with acute traumatic spinal cord injury.

The value of pre-hospital trauma life support courses for medical personnel-a questionnaire study.

The aim of the study was to determine the impact that PHTLS® course participation had on self-confidence of emergency personnel, regarding the pre-hospital treatment of patients who had suffered severe trauma. Furthermore, the goal was to determine the impact of specific medical profession, work experience and prior course participation had on the benefits of PHTLS® training. A structured questionnaire study was performed. Healthcare providers from local emergency services involved in pre-hospital care in the metropolitan area of Zurich (Switzerland, Europe) who completed a PHTLS® course were included. Altered self-confidence, communication, and routines in the treatment of severe trauma patients were examined. The impact of prior course participation, work experience and profession on course benefits were evaluated. The response rate was 76%. A total of 6 transport paramedics (TPs), 66 emergency paramedics (EPs) and 15 emergency doctors (EDs) were included. Emergency paramedics had significantly more work experience compared with EDs (respectively 7.1 ± 5.7 yrs. vs. 4.5 ± 2.1 yrs., p = 0.004). 86% of the participants reported increased self-confidence in the pre-hospital management of severe trauma upon PHTLS® training completion. Moreover, according to 84% of respondents, extramural treatment of trauma changed upon course completion. PHTLS® course participants had improved communication in 93% of cases. This was significantly more frequent in EPs than TPs (p = 0.03). Multivariable analysis revealed emergency paramedics benefit the most from PHTLS® course participation. The current study shows that PHTLS® training is associated with improved self-confidence and enhanced communication, with regards to treatment of severe trauma patients in a pre-hospital setting, among medical emergency personnel. Additionally, emergency paramedics who took the PHTLS® course improved in overall self-confidence. These findings imply that all medical personal involved in the pre-hospital care of trauma patients, in a metropolitan area in Europe, do benefit from PHTLS® training. This was independent of the profession, previous working experience or prior alternative course participation.

The effect of ambient outside temperatures on scoop stretchers

Background: Scoop stretchers are commonly used in the prehospital care of trauma patients. Patients' clothing is often removed early in the care pathway. There may be unidentified risks if scoop stretchers are particularly cold. Aims: The primary aim of this research was to establish if there is a positive correlation between scoop temperatures and outside temperatures when this equipment is stored without access to vehicle heating. Methods: The authors recruited volunteers at ambulance locations across Scotland to measure scoop temperatures using infrared thermometers. These were compared to outside temperatures at that time. Data were subject to bivariate quantitative analysis to assess correlation strength. Findings: Results demonstrated that there was a moderate-to-strong correlation between scoop temperatures and outside temperatures (mean +3.0°C; P<0.001). There was no significant difference for other variables measured. Conclusion: Without active heating, scoop stretchers will be only marginally warmer than the outside temperature, sometimes colder than the outside temperature and sometimes below freezing point.

Prehospital Care of Trauma Patients in Los Angeles County During the Early COVID-19 Pandemic.

Prehospital Care of Trauma Patients in Los Angeles County During the Early COVID-19 Pandemic.

Retrospective autopsy-based survey of fatal traumatic brain injuries in Benin City, Nigeria

Background: Traumatic brain injury (TBI) is major cause of death in young adults. It results from external force to the head causing injury to the contents of the skull with or without damage to the skull itself.
 Aims and objectives: To describe the autopsy findings in patients with Traumatic brain injuries.Materials and Methods: A Retrospective Study of findings in patients who suffered Traumatic Brain Injuries as seen at autopsy. The historical and autopsy data of all Traumatic brain injury patients whose bodies were received between 2011 and 2021 were analyzed.
 Results: TBIs account for 66.7% of traumatic deaths in our institution. Male to female ratio was 1:0.22, and mean age was 39.30±16.65 years. The most common cause of TBI was road traffic accidents (90.9%), with gunshots (5.6%) as a distant second. Intracranial hemorrhages were present in 99.6% of cases and almost all (98.8%) died as a result of Raised Intracranial pressure associated with intracranial hemorrhage. The most common pattern was Subdural hemorrhage (62.65%); followed by Subarachnoid hemorrhage (52.35%); Intraparenchymal hemorrhage (40.88%), Epidural hemorrhage (18.24%); and intraventricular hemorrhage (9.71%). Skull fractures were present in 41.6% of cases. 
 Conclusion: RTA is the most common cause of traumatic brain injury in our study and the leading cause of traumatic deaths. Multiple injuries appears to contribute less to mortality amongst our TBI patients but this may be due to under reporting of injuries found in polytraumatized patients. Morbidity and mortality due to TBI, and trauma in general, will be reduced by improving road safety, and functional protocols for emergency and prehospital care of trauma patients.

Prehospital care of trauma patients in Tanzania: medical knowledge assessment and proposal for safe transportation of neurotrauma patients.

A descriptive, cross-sectional survey of individuals involved in prehospital transportation of neurotrauma patients was performed. Little is known about prehospital care of neurotrauma patients in low- and middle-income countries. This study sought to assess the knowledge of prehospital transporters in Tanzania and propose an educational intervention to help identify patients with severe neurotrauma. Dar es Salaam, Tanzania. Surveys assessed demographic information and medical knowledge with three outcomes of identifying signs of a deceased, sick, or clinically deteriorating patient. Predictors of increased medical knowledge were investigated with univariate and multivariate logistic regression (MLR). The survey included 501 participants, who were predominantly young (mean: 36.7 years) and male (84.0%). More than 70% of participants self-reported being able to recognize a deceased or sick patient, yet fewer than 20% correctly listed more than two signs of a deceased, sick, or clinically deteriorating patient. MLR showed that first aid training (Odds ratio (OR): 2.3; 95% confidence interval (CI): 1.3, 3.9; p = 0.002) was predictive of identifying a deceased patient, being employed (OR: 0.5; 95% CI: 0.3, 0.9; p = 0.021) was a negative predictor of identifying a sick patient, and higher education level (OR: 2.3; 95% CI: 1.1, 4.8; p = 0.032) was predictive of identifying a clinically deteriorating patient. In a survey of prehospital transporters of neurotrauma patients in Tanzania, higher education level and first aid training were associated with higher medical knowledge scores. An educational flier was created to identify severe neurotrauma patients. Additional education of prehospital transporters in Tanzania may improve morbidity and mortality of neurotrauma patients.

The association between time intervals in emergency medical services and In-hospital mortality of trauma patients

Context: While the clinical practice recommends field stabilization in trauma patients, in some situations, the speed of transport is crucial. Aims: This study aimed to evaluate the association between emergency medical services (EMS) time intervals (response time [RT], scene time [ST], and transport time [TT]) and in-hospital mortality in trauma patients in Tehran, the largest metropolis of Iran. Settings and Design: A prospective cohort study was conducted between May 2017 and April 2018. Methods: All EMS operations related to trauma events in the Tehran city that were transferred to three targeted major trauma centers were included. Statistical Analysis: Logistic regression analysis was used to assess the relationship between EMS time intervals and other risk factors of trauma death. Results: A total of 14,372 trauma patients were included in the final analysis. In-hospital mortality occurred in 225 (1.6%) patients. After adjustment for confounding variables, older age (odds ratio [OR] = 1.04/year), female gender (OR = 2.16), low Mechanism, Glasgow Coma Scale (GCS), age, and arterial pressure score (OR = 0.84 for each unit), low GCS (OR = 0.56 for each unit), longer ST (OR = 1.17/10 min), and longer TT (OR = 1.21/10 min) were found to be risk factors for death in trauma. Conclusions: Our study showed that in-hospital mortality of trauma patients correlated with longer EMS ST and TT, but the RT was not associated with mortality. Our results recommend that the EMS system should consider ST and TT rather than RT, as indexes of quality control in prehospital care of trauma patients.

Association between Blood Glucose and cardiac Rhythms during pre-hospital care of Trauma Patients \u2013 a retrospective Analysis

BackgroundDeranged glucose metabolism is frequently observed in trauma patients after moderate to severe traumatic injury, but little data is available about pre-hospital blood glucose and its association with various cardiac rhythms and cardiac arrest following trauma.MethodsWe retrospectively investigated adult trauma patients treated by a nationwide helicopter emergency medical service (34 bases) between 2005 and 2013. All patients with recorded initial cardiac rhythms and blood glucose levels were enrolled. Blood glucose concentrations were categorised; descriptive and regression analyses were performed.ResultsIn total, 18,879 patients were included, of whom 185 (1.0%) patients died on scene. Patients with tachycardia (≥100/min, 7.0 ± 2.4 mmol/L p < 0.0001), pulseless ventricular tachycardia (9.8 ± 1.8, mmol/L, p = 0.008) and those with ventricular fibrillation (9.0 ± 3.2 mmol/L, p < 0.0001) had significantly higher blood glucose concentrations than did patients with normal sinus rhythm between 61 and 99/min (6.7 ± 2.1 mmol/L). In patients with low (≤2.8 mmol/L, 7/79; 8.9%, p < 0.0001) and high (> 10.0 mmol/L, 70/1271; 5.5%, p < 0.0001) blood glucose concentrations cardiac arrest was more common than in normoglycaemic patients (166/9433, 1.8%). ROSC was more frequently achieved in hyperglycaemic (> 10 mmol/L; 47/69; 68.1%) than in hypoglycaemic (≤4.2 mmol/L; 13/31; 41.9%) trauma patients (p = 0.01).ConclusionsIn adult trauma patients, pre-hospital higher blood glucose levels were related to tachycardic and shockable rhythms. Cardiac arrest was more frequently observed in hypoglycaemic and hyperglycaemic pre-hospital trauma patients. The rate of ROSC rose significantly with rising blood glucose concentration. Blood glucose measurements in addition to common vital parameters (GCS, heart rate, blood pressure, breathing frequency) may help identify patients at risk for cardiopulmonary arrest and dysrhythmias.

The Association of Prehospital Intravenous Fluids and Mortality in Patients with Penetrating Trauma

BackgroundThe optimal approach to prehospital care of trauma patients is controversial, and thought to require balancing advanced field interventions with rapid transport to definitive care. ObjectiveWe sought principally to examine any association between the amount of prehospital IV fluid (IVF) administered and mortality. MethodsWe conducted a retrospective cohort analysis of trauma registry data patients who sustained penetrating trauma between January 2008 and February 2011, as identified in the Pennsylvania Trauma Systems Foundation registry with corresponding prehospital records from the Philadelphia Fire Department. Analyses were conducted with logistic regression models and instrumental variable analysis, adjusted for injury severity using scene vital signs before the intervention was delivered. ResultsThere were 1966 patients identified. Overall mortality was 22.60%. Approximately two-thirds received fluids and one-third did not. Both cohorts had similar Trauma and Injury Severity Score−predicted mortality. Mortality was similar in those who received IVF (23.43%) and those who did not (21.30%) (p = 0.212). Patients who received IVF had longer mean scene times (10.82 min) than those who did not (9.18 min) (p < 0.0001), although call times were similar in those who received IVF (24.14 min) and those who did not (23.83 min) (p = 0.637). Adjusted analysis of 1722 patients demonstrated no benefit or harm associated with prehospital fluid (odds ratio [OR] 0.905, 95% confidence interval [CI] 0.47–1.75). Instrumental variable analysis utilizing variations in use of IVF across different Emergency Medical Services (EMS) units also found no association between the unit's percentage of patients that were provided fluids and mortality (OR 1.02, 95% CI 0.96–1.08). ConclusionsWe found no significant difference in mortality or EMS call time between patients who did or did not receive prehospital IVF after penetrating trauma.

Subjective safety and self-confidence in prehospital trauma care and learning progress after trauma-courses: part of the prospective longitudinal mixed-methods EPPTC-trial

BackgroundPrehospital trauma care is stressful and requires multi-professional teamwork. A decrease in the number of accident victims ultimately affects the routine and skills and underlines the importance of effective training. Standardized courses, like PHTLS, are established for health care professionals to improve the prehospital care of trauma patients. The aim of the study was to investigate the subjective safety in prehospital trauma care and learning progress by paramedics in a longitudinal analysis.MethodsThis was a prospective intervention trial and part of the mixed-method longitudinal EPPTC-trial, evaluating subjective and objective changes among participants and real patient care as a result of PHTLS courses. Participants were evaluated with pre/post questionnaires as well as one year after the course.ResultsWe included 236 datasets. In the pre/post comparison, an increased performance could be observed in nearly all cases. The result shows that the expectations of the participants of the course were fully met even after one year (p = 0.002). The subjective safety in trauma care is significantly better even one year after the course (p < 0.001). Regression analysis showed that (ABCDE)-structure is decisive (p = 0.036) as well as safety in rare and common skills (both p < 0.001). Most skills are also rated better after one year. Knowledge and specific safety are assessed as worse after one year.ConclusionThe courses meet the expectations of the participants and increase the subjective safety in the prehospital care of trauma patients. ABCDE-structure and safety in skills are crucial. In the short term, both safety in skills and knowledge can be increased, but the courses do not have the power to maintain knowledge and specific subjective safety issues over a year.Trial registrationGerman Clinical Trials Register, ID DRKS00004713, registered 14. February 2014

Whole Blood Stored at 4°C for 7 Days Is Equivalent to Fresh Whole Blood for Resuscitation of Severe Polytrauma

Background: Currently, whole blood is rarely used in trauma resuscitation due, in part, to the widely held belief that refrigeration will reduce the hemostatic efficacy of stored platelets. Recently, however, Pidcoke et al. (Transfusion 2013, 53:137s) showed that hemostatic function of human whole blood was well preserved when stored at 4°C for up to 21 days. The hemostatic and resuscitative efficacy of cold-stored whole blood has not been tested in a coagulopathic animal polytrauma model.Hypothesis: We hypothesized that blood stored for 7 days at 4°C is equivalent to fresh whole blood with regard to hemostatic and coagulation function in resuscitation of severe trauma.Method: Sprague-Dawley rats (300-400g) were anesthetized with Isoflurane. Polytrauma was induced by damaging the small intestines, the left and medial liver lobes, the right leg skeletal muscle, and by fracturing the right femur. The rats were then bled to a mean arterial pressure of 40mmHg and held there until 40% of the blood volume was removed. Hemorrhage was usually completed between 30-60 min. Resuscitation was started at 1hr and included the following groups: Lactated Ringer’s (LR), fresh whole blood (FWB) or FWB stored at 4°C for 7 days (sFWB). The resuscitation volume was 20% of blood volume and represents the approximate volume used in prehospital care of trauma patients in both civilian and military settings. The experiment was terminated at 2hrs. Blood samples were taken before (time 0) and 2hrs after trauma (1hr after resuscitation) to assess hemostatic function. Prothombin time (PT), activated partial thromboplastin time (aPTT) and fibrinogen were measured on ST-4 (Stago). Platelet aggregation was measured with Multiplate (Diapharma) after stimulation with ADP, collagen or thrombin (PAR4) and expressed as area under the curve per 1000 platelets. Clotting function was assessed using ROTEM (Tem International).Results: Resuscitation with FWB and sFWB led to recovery of mean arterial blood pressure to levels similar to baseline (FWB 92±2.4 to 86±3, sFWB 93±3 to 91±4). Resuscitation with LR led to a significantly lower arterial pressure (96±3 to 61±3.8mmHg, p<0.05). Plasma lactate levels were significantly elevated in all groups. However, plasma lactate was lower after resuscitation with FWB and sFWB (0.52±0.06 to 1.22±0.08, and 0.5±0.05 to 1.28±0.12mM, respectively), as compared to LR (0.47±0.05 to 2.36±0.24mM). Several coagulation parameters changed significantly after resuscitation (PT, aPTT, fibrinogen, mean clotting firmness, clotting time and alpha angle). However, there was no difference in the change of any of these parameters between animals treated with FWB or sFWB. Because platelets make up most of the clot strength, we assessed the ability of agonists (ADP, thrombin agonist, collagen) to stimulate platelet aggregation. The degree of aggregation after resuscitation with all fluids was significantly decreased to stimulation with collagen (15 to 26%). However there was no significant difference in the aggregation changes between the FWB or sFWB groups. Resuscitation with any of the fluids had no effect on ADP or PAR4 stimulation of aggregation.Conclusion: These data strongly suggest that FWB and FWB stored for 7days at 4° are equivalent for treating severe polytrauma and hemorrhage when considering recovery of arterial pressure and plasma lactate, changes in clotting function and changes in platelet aggregation as endpoints necessary for recovery of the patient. This project was funded by the US Army Medical Research and Materiel Command. DisclosuresNo relevant conflicts of interest to declare.

Continuing Professional Development: Tranexamic acid in the pre-hospital care of trauma patients

Overview This Continuing Professional Development (CPD) module will explore the use of tranexamic acid (an antifibrinolytic) in pre-hospital trauma patients. A review of the current guidelines is provided along with considerations for its use in the future. Learning Outcomes After completing this module you will be able to: • Recognise when to use tranexamic acid in the care of trauma patients. • Understand the mechanism of action of tranexamic acid. • Gain an overview of recommended dose and volume of tranexamic acid for trauma patients. • Recognise exclusion criteria for the administration of tranexamic acid.

The effect of paramedic training on pre-hospital trauma care (EPPTC-study): a study protocol for a prospective semi-qualitative observational trial

BackgroundAccidents are the leading cause of death in adults prior to middle age. The care of severely injured patients is an interdisciplinary challenge. Limited evidence is available concerning pre-hospital trauma care training programs and the advantage of such programs for trauma patients. The effect on trauma care procedures or on the safety of emergency crews on the scene is limited; however, there is a high level of experience and expert opinion.MethodsI – Video-recorded case studies are the basis of an assessment tool and checklist being developed to verify the results of programs to train participants in the care of seriously injured patients, also known as “objective structured clinical examination” (OSCE). The timing, completeness and quality of the individual measures are assessed using appropriate scales. The evaluation of team communication and interaction will be analyzed with qualitative methods and quantified and verified by existing instruments (e.g. the Clinical Team Scale). The developed assessment tool is validated by several experts in the fields of trauma care, trauma research and medical education. II a) In a German emergency medical service, the subjective assessment of paramedics of their pre-hospital care of trauma patients is evaluated at three time points, namely before, immediately after and one year after training. b) The effect of a standardized course concept on the quality of documentation in actual field operations is determined based on three items relevant to patient safety before and after the course. c) The assessment tool will be used to assess the effect of a standardized course concept on procedures and team communication in pre-hospital trauma care using scenario-based case studies.DiscussionThis study explores the effect of training on paramedics. After successful study completion, further multicenter studies are conceivable, which would evaluate emergency-physician staffed teams. The influence on the patients and prehospital measures should be assessed based on a retrospective analysis of the emergency room data.Trials registrationGerman Clinical Trials Register, ID DRKS00004713.

Operating Room Use of Hypertonic Solutions: A Clinical Review

Hyperosmotic-hyperoncotic solutions have been widely used during prehospital care of trauma patients and have shown positive hemodynamic effects. Recently, there has been a growing interest in intra-operative use of hypertonic solutions. We reviewed 30 clinical studies on the use of hypertonic saline solutions during surgeries, with the majority being cardiac surgeries. Reduced positive fluid balance, increased cardiac index, and decreased systemic vascular resistance were the main beneficial effects of using hypertonic solutions in this population. Well-designed clinical trials are highly needed, particularly in aortic aneurysm repair surgeries, where hypertonic solutions have shown many beneficial effects. Examining the immunomodulatory effects of hypertonic solutions should also be a priority in future studies.

Musculoskeletal Trauma Service in Thailand

Trauma is becoming a leading cause of death in most of the low-income and middle-income countries worldwide. The growing number of motor vehicles far surpasses the development and upkeep of the road and highway networks, traffic laws, and driver training and licensing. In Thailand, road traffic injuries have become the second leading cause of death and morbidity overall since 1990. The lack of improvement to existing roadways, implementation of traffic safety and ridership laws including seatbelt regulations, and poor emergency medical assistance support systems all contribute to these statistics. An insufficient number and inequitable distribution of healthcare professionals is also a national problem, especially at the district level. Prehospital care of trauma patients remains insufficient and improvements at the national level are suggested.

From Roadside to Hospital: A Pilot Study to Investigate the Factors Influencing the Time Taken to Deliver Trauma Patients to a Regional Hospital

Introduction One of the trauma system objectives for the ambulance service is to get the right patient to the right hospital in a timely manner. The Review of Trauma and Emergency Services in Victoria, Australia, identified prolonged prehospital scene times of greater than 20 minutes for non trapped patients as a deficiency that may have adverse outcomes for severely injured trauma patients. The objective of this pilot study was to identify the factors that impact on the timely transfer of trauma patients from the scene of an incident to a regional hospital emergency department and justification for the delays, as the basis for a further detailed study. Methods A retrospective pilot cohort study of trauma patients transported by ambulance to the emergency department of the Latrobe Regional Hospital over a six-month period who had an emergency department triage category of 1, 2 or 3 was undertaken. Data relating to the prehospital care of trauma patients with scene times &gt; 20 minutes and transport times &gt; 30 minutes were extracted from Rural Ambulance Victoria patient care records and hospital patient records. Ethics approval was granted. Results There were 70 trauma patients transported to the hospital during the collection period. Of these 49 patients were available for analysis, 21 cases were excluded due to incomplete time or ED triage details. There were 12 cases where scene times were &gt; 20 minutes. Only one paramedic crew spent an unjustifiably long time at the scene and only one patient had a transport time to hospital &gt; 30 minutes. Conclusion This pilot study confirms that there are prolonged prehospital scene times involving paramedics, however, the study suggests that most of the extended times are explained by factors outside the control of the attending paramedics. There was only one case where the scene time was not justified. One patient had a transport time &gt; 30 minutes which was due to the patient being taken to a higher level of care. Experiences from this pilot study have led to changes in subsequent prehospital trauma studies.

T HE D EVELOPMENT OF A R EGISTER OF R ANDOMIZED C ONTROLLED T RIALS IN P REHOSPITAL T RAUMA C ARE

Objectives. To establish a register of randomized controlled trials of interventions in the prehospital care of trauma patients. Methods. A systematic search was conducted for all randomized controlled trials of interventions in the prehospital care of trauma patients. The search included the Cochrane Controlled Trial Register, the Cochrane Injuries Group Specialised Register, Medline, EMBASE, the Cumulative Index to Nursing & Allied Health Literature (CINAHL), Science Citation Index, National Research Register, Dissertation s, and PubMed for the time period 1966–2000. There were no language restrictions. In addition, full-text hand searching of a range of relevant journals was done, and the authors of included trials were contacted. Results. The combined search strategy identified 16,037 potentially eligible records, of which 28 were reports of randomized controlled trials evaluating prehospital trauma care interventions. After excluding duplicate reports, there were 24 separate randomized controlled trials including 6,806 patients. The largest and smallest trials involved 1,309 and 30 trauma patients, respectively. Conclusions. This register will facilitate the conduct of systematic reviews of the effectiveness of interventions in prehospital trauma care. However, despite the extensive searching, very few randomized trials in this area were found. In view of the absence of evidence for the effectiveness of many of the interventions that are used in the prehospital care of trauma patients, further randomized controlled trials are required.