Would a delayed transport time make a difference in your opinions on fluid resuscitation in the field. Maybe I should have made my agencies needs a little more clear. We have an average response time from our ALS provider of 30 minutes, that's on a good day in the summer. On a bad day in the winter at the far reaches of our coverage area we may be looking at 60 minutes or more. We bring in life flight when needed but weather often will keep them from making it in. Ground transport to the nearest med center is at best going to take 45 minutes, level one will be an additional 15 minutes, There are all sorts of relay and meet options but for easy figuring lets use the following scenario. We are looking at 20 minutes to respond to the scene,an additional 45 minutes for arrival of ALS and a 60 minute transport time. We have critically injured patients from an MVA, they may already be hypothermic after being exposed to the elements (a very frequent scenario in our area), if we are looking at the above time frame (2+ hours) before our patients hit the ED doors would you be okay with providing warm fluids as long as protocols are followed? If not could you explain why.
Absolutely not! Your fluid resuscitation might actually kill the patient in your scenario. Lets break down why.
You are going to be decreasing the hematocrit (% of RBCs in blood/volume) by providing saline or ringers to this patient, which will further drop oxygen carrying capacity of the blood, which will make the shock
even worse. Remember that shock is not defined by BP or blood loss, but by lack of perfusion of oxygenated blood to vital tissue beds. The treatment for blood loss secondary to trauma is
not fluid replacement, but surgery to stop the blood loss. I reccommend Dr. Jeffery Guy's lectures available through iTunes for free. Guy is a burn and trauma surgeon attending at Vanderbelt University . Leading experts in trauma are strongly recommending against aggressive fluid resuscitation in the field and the ED. The only safe fluid for these patients is of course blood, and in your case in the field, O-, which you are not going to have access to.
Also, as you stated, the patient is hypothermic. You might remember to warm the fluids, but others may not. Water has an excellent capacity to remain cool, which is one of the reasons our body uses it in the first place.
If I was an ALS provider, I would start an IV on this patient and provide no fluids unless the blood pressure was below 90. Than I would titrate to control it at around 90 mmhg. It would be dangerous for me to do such, and I would be high tailing it to the trauma center (safely of course). It would be even worse for EMTs to initiate this treatment while waiting for ALS.
