AN UPDATE ON PREHOSPITAL MANAGEMENT OF MAJOR TRAUMA

Abstract

INTRODUCTION The goals of pre-hospital care for severe trauma are the detection of lifethreatening injuries, the early application of therapeutic measures and the timely transfer to an appropriate hospital centre. The response of the emergency services to major trauma incidents involves different responders with specific functions and in a variety of often challenging contexts. Therefore, a common language, preparation and coordination are essential to ensure compliance with the goals and quality of care. OBJECTIVE To carry out an update on the management of the adult trauma patient based on new evidence and practices. METHODS Literature review search mainly through PubMed. A secondary search on UptoDate and the latest editions of reference books on prehospital and advanced major trauma, and in reference organizations such as Difficult Airway Society, Advanced Trauma Life Support, European Trauma Course, and Anaesthesia, Trauma and Critical Care Course (ATACC). A tertiary search through the references in the UpToDate guidelines to identify new sources. Search terms included: prehospital care, major trauma, difficult airway, permissive hypotension, immobilization, both in Spanish and English. RESULTS The management of catastrophic bleeding is the first step in the primary assessment, because it can cause death even before an obstructed airway. Airway management and ventilation remain a priority. Permissive hypotension is increasingly accepted in the management of major trauma with hypovolemic shock except in the case of patients with head trauma. Prevention and control of the deadly triad (acidosis, hypoxia and hypothermia) improve the prognosis. An “excessive stabilization” approach should be avoided, so that access to definitive treatment is not delayed. CONCLUSIONS Prehospital trauma care is necessarily multidisciplinary, requiring coordination and communication between teams to ensure quality of care.