PREHOSPITAL ADVANCED TRAUMA LIFE-SUPPORT FOR CRITICAL BLUNT TRAUMA VICTIMS

The ability of paramedics to deliver advanced trauma life support (ATLS) in an expedient fashion for victims of trauma has been strongly challenged. In this study, the records of 114 consecutive victims of blunt trauma who underwent laparotomy or thoracotomy were reviewed. Prehospital care was rendered by paramedics operating under strict protocols. The mean response time (minutes ± SEM) to the scene was 5.6 ± 0.27. On-scene time was 13.9 ± 0.62. The time to return to the hospital was 8.0 ± 0.4. On-scene time included assessing hazards at the scene, patient extrication, spine immobilization (n = 98), application of oxygen (n = 94), measurement of vital signs (n = 114), splinting of 59 limbs, and the following ATLS procedures: endotracheal intubation (n = 31), IV access (n =106), ECG monitoring (n = 69), procurement of blood for tests including type and cross (n = 58), and application of a pneumatic antishock garment (PASG) (n = 31). On-scene times were analyzed according to the number of ATLS procedures performed: insertion of one IV line (n = 46), 14.8 ± 1.03 minutes; two IV lines (n = 28), 13.4 ± 0.92; one IV line plus intubation (n = 7), 14.0 ± 2.94; two IV lines plus intubation (n=9), 17.0 ± 2.38; and two IV lines plus intubation plus PASG (n = 13), 12.4 ± 1.36. Of the 161 IV attempts, 94% were completed successfully Of 36 attempts at endotracheal intubation, 89% were successful. Sixteen additional trauma patients were studied prospectively: the time required to place an IV line was 2.98 ± 0.37 minutes. Of 87 patients who had any vital signs in the field, 73 survived (83%). We conclude that paramedics functioning under direct medical control can perform basic life support and ATLS procedures at the scene in an expeditious manner. © 1987 American College of Emergency Physicians.