What are the EMS and prehospital consensus statements in trauma since 2023 from ACEP (American College of Emergency Physicians), NAEMT (National Association of Emergency Medical Technicians), and NAEMSP (National Association of EMS Physicians) regarding prehospital antibiotics?

From the Guidelines

The administration of prehospital antibiotics in trauma patients, particularly those with open fractures and penetrating trauma, is strongly recommended to reduce the risk of infection and improve outcomes, as emphasized by recent guidelines from organizations such as ACEP, NAEMT, and NAEMSP 1. The most recent and highest quality study, published in 2024, provides evidence-based guidelines for the management of geriatric trauma patients, including the use of antibiotic prophylaxis in penetrating trauma, severely burned patients, and open fractures to decrease septic complications 1. Key points to consider in prehospital antibiotic administration include:

• Early administration of antibiotics, ideally within one hour of injury, to reduce the risk of infection
• The use of cefazolin or clindamycin as the preferred regimen for most open fractures, with additional gram-negative coverage for heavily contaminated wounds or farm injuries
• The consideration of local antibiotic prophylactic strategies, such as vancomycin powder or gentamicin-covered nails, as an adjunct to systemic antibiotics
• The importance of hemorrhage control, balanced blood product resuscitation, and temperature management in prehospital trauma care, as highlighted by recent consensus statements 1. It is essential to note that the management of elderly trauma patients requires a focused approach, including knowledge of ageing physiology, frailty assessment, and early activation of trauma protocol to improve outcomes 1. In terms of specific antibiotic regimens, the guidelines recommend:
• Cefazolin 2g IV for most open fractures
• Addition of gentamicin 5mg/kg IV for heavily contaminated wounds or farm injuries
• Clindamycin 600-900mg IV as an alternative for penicillin-allergic patients These recommendations aim to provide antimicrobial coverage before bacterial colonization becomes established, reducing the risk of infection and improving patient outcomes 1.

From the Research

Prehospital Antibiotics Consensus Statements

• The American College of Emergency Physicians (ACEP), National Association of Emergency Medical Technicians (NAEMT), and National Association of EMS Physicians (NAEMSP) have issued consensus statements regarding prehospital antibiotics in trauma patients since 2023 2.
• The statements recommend the administration of prophylactic antibiotics, specifically cefazolin, to patients with suspected open fractures, after management of life threats and without delaying transport 2.
• The use of prehospital antibiotics is considered safe and may be beneficial in reducing the risk of infection in trauma patients, particularly those with open fractures 3, 4, 2, 5.

Key Recommendations

• In responsive patients with no history of penicillin or cephalosporin allergy, EMS should administer a 1st generation cephalosporin after managing life threats and without delaying transport 2.
• In obtunded patients, EMS should administer a 1st generation cephalosporin after managing life threats and without delaying transport 2.
• In responsive patients with a documented penicillin allergy, EMS should administer a 1st generation cephalosporin with close monitoring after managing life threats and without delaying transport 2.

Evidence and Justification

• Studies have shown that prehospital administration of antibiotics is safe and effective in reducing the risk of infection in trauma patients 3, 4, 5.
• The use of cefazolin as a prophylactic antibiotic is recommended due to its efficacy and safety profile 4, 2, 5.
• The administration of prehospital antibiotics should be guided by local protocols and patient-specific factors, such as the presence of allergies or life-threatening injuries 3, 2.