Pre-hospital initiation of fluid replacement therapy in trauma

Ambulance trusts and clinicians who have been trained in advanced life support and pre-hospital care should review their current practice and policies to take account of the guidance set out in section 1.

Any local adaptations of the Joint Royal Colleges Ambulance Liaison Committee (JRCALC) guidelines that refer to the pre-hospital initiation of fluid replacement therapy in trauma should incorporate the guidance.

To measure compliance locally with the guidance, the following criteria could be used. Further details on suggestions for audit are presented in appendix A.

• A: Intravenous (IV) fluid is not administered as part of pre-hospital management of an adult or older child if a radial pulse, or with a penetrating torso injury, a central pulse, can be felt.

• B: IV fluid in boluses of no more than 250 ml is administered if no radial pulse is palpable (or no central pulse is detected in the case of a penetrating torso injury), followed by reassessment, repeating the process until a radial (or central) pulse is palpable.

• C: If IV fluid is administered for the circumstances described in criteria A and B, it is initiated en route to hospital (excluding individuals who are not considered appropriate to move).

• D: When IV fluid is indicated in the pre-hospital setting, crystalloid solutions are the routine choice.

• E: Only healthcare professionals who have been appropriately trained in ALS and pre-hospital care administer IV fluid to people experiencing trauma in the pre-hospital setting.

• F: Training programmes for healthcare professionals caring for people experiencing trauma incorporate the guidance in section 1.

Local clinical audits could also include measurement of compliance with other relevant clinical guidance such as JRCALC guidelines and the Consensus Statement.