AB or ABC: pre-hospital fluid management in major trauma

Pre-hospital trauma care in the United Kingdom is a neglected field with little consideration being given to this phase. Of the 14,500 annual fatalities from road traffic accidents in this country, 60% die before reaching hospital and it has been estimated that one-third of these fatalities are due to hypovolaemia. The pre-hospital fluid resuscitation of trauma patients is a controversial area and although it would seem sensible to commence intravenous (i.v.) fluids at the roadside, several large studies have failed to show any benefit from this intervention. By delaying departure to hospital, initiation of i.v. fluid replacement may actually worsen outcome. This paper reviews recent studies and discusses current thought on pre-hospital fluid replacement in major trauma.