What are the Emergency Medical Services (EMS) and prehospital consensus statements in trauma care since 2023?

From the Guidelines

Since 2023, the most significant EMS and prehospital consensus statement in trauma care emphasizes the importance of minimizing time from injury to intervention, with a focus on early hemorrhage control and swift pre-hospital care, as highlighted in the European guideline on management of major bleeding and coagulopathy following trauma: sixth edition 1.

Key Recommendations

• The updated guidelines stress the need for regionalization of trauma management, with designated trauma centers that offer different levels of care and interact with pre-hospital emergency medical services, as this has been shown to improve trauma care and reduce mortality 1.
• There is a consensus that trauma patients in need of emergency intervention for ongoing hemorrhage have increased chances of survival if the elapsed time between injury and start of the intervention is minimized, with every additional minute in pre-hospital response time correlating with a 2% increase in mortality, and every additional minute in pre-hospital scene time correlating with a 1% increase in mortality 1.
• The use of tourniquets, hemostatic gauze, and pelvic binders is recommended for early hemorrhage control, with the tactical tourniquet being a potentially lifesaving technique in cases of severe limb trauma with no radial pulse or cardiac arrest 1.
• The guidelines also emphasize the importance of timely in-hospital trauma management, including door-to-needle time, and the use of point-of-care ultrasound (POCUS) in the field for trauma assessment and telemedicine for remote physician guidance during complex trauma scenarios.

Rationale

The rationale behind these recommendations is based on the evidence that minimizing time from injury to intervention, and providing swift and effective pre-hospital care, can significantly reduce mortality and improve outcomes in trauma patients 1.

Key Points

• Minimizing time from injury to intervention is crucial in trauma care
• Early hemorrhage control using tourniquets, hemostatic gauze, and pelvic binders is recommended
• Swift pre-hospital care and timely in-hospital trauma management are essential
• The use of POCUS and telemedicine can enhance trauma assessment and management in the field.

From the Research

Emergency Medical Services (EMS) and Prehospital Consensus Statements in Trauma Care

There are no research papers since 2023 to assist in answering this question. However, based on the available studies, the following points can be noted:

• The use of whole blood administration in the prehospital setting may improve early shock severity, coagulopathy, and survival in traumatically injured patients 2.
• Prehospital immobilization of patients with potential spinal cord injuries using a cervical collar, head immobilization, and a spinal board is recommended 3.
• The need for trauma management training and evaluation in a prehospital setting has been identified, with a focus on stabilizing trauma patients and developing a system to objectively evaluate trauma management 4.
• Spinal immobilization in prehospital and emergency care settings has been a topic of debate, with some studies supporting and others opposing its use 5.
• Prehospital management of traumatic brain injury is crucial, with goals of care including recognition of life-threatening raised intracranial pressure, prevention of secondary injury, and management of brain oxygenation, blood pressure, and cerebral perfusion pressure 6. Some key points to consider in prehospital trauma care include:
• The importance of timely and appropriate resuscitation and stabilization of trauma patients
• The need for trained personnel and equipment to manage traumatic injuries in the prehospital setting
• The importance of spinal immobilization and cervical spine clearance in patients with potential spinal cord injuries
• The need for ongoing evaluation and improvement of prehospital trauma care protocols and practices.