Prehospital guidelines for use of hypertonic saline are not followed systematically

Hypertonic saline (HS) was introduced in our physician-based mobile emergency care unit (MECU) in September 2006 for patients with severe traumatic brain injury and hypotension. HS has, however, rarely been used and we sought to identify barriers to its implementation.

We conducted a survey based on a questionnaire administered to all 40 anaesthesiologists employed at the MECU in Copenhagen as per August 2010.

A total of 31 anaesthesiologists (84%) returned the questionnaire. Three physicians were excluded because of leave. Almost half of the physicians considered the evidence for use of HS insufficient, and 29% found that guidelines were lacking. Noticeable barriers were inadequate familiarity with and unawareness of the guideline. Some believed that they may have failed to use HS because the option did not occur to them during the relevant incidents. Many physicians stated that training at the MECU should be more thorough and that instructions were missing.

Barriers to the implementation of HS were lack of familiarity with the guideline and disagreement regarding the evidence supporting its use. Possible solutions to these implementation issues include additional instructions and internal MECU meetings

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