Équipement des Smur pour la prise en charge préhospitalière du choc hémorragique : peut mieux faire !

Introduction

Hemorrhagic shock is an emergency, which may benefit from a medicalized prehospital care. Our goal was to survey the means available in the 370 French prehospital medicalized emergency services (SMUR) for hemorrhagic situations.

Methods

Multicenter descriptive observational study by email then phone with all the 370 French SMUR leaders. The questionnaire was created by investigators of the project through a Delphi method, and was about service protocols concerning hemorrhagic patient care, hemorrhagic parameters measure equipment available, intravenous solutes and drugs as well as various medical devices useful or perceived to be useful to support prehospital hemorrhagic shock. The results are expressed in numbers and percentages.

Results

The overall response rate was 48% (n = 178). Protocols were established in between 43% (n = 76) and 47% (n = 83) according to etiology, measuring devices were available in 5% (n = 9) of the Smur for hemostasis up to 89% (n = 158) for hemoglobin measurement. Available intravenous solutes were mainly isotonic salty serum (95%, n = 169), hydroxylethylstarch (83%, n = 148) and Ringer lactate (73%, n = 130). Tranexamic acid was available in 84 (47%) Smur. The teams had access to erythrocytes concentrates, fresh frozen plasma and platelets in 84% (n = 150), 44% (n = 79) and 23% (n = 41) respectively. Eighty-one (46%) Smur had tourniquets and 127 (71%) anti-shock trousers. Finally, 57 (32%) had a pelvic restraint belt.

Conclusion

There is a great disparity in the means available in the French Smur for the support of prehospitalization bleeding. The majority the Smur physicians can transfuse in a prehospital setting. On the other hand, a minority of teams can actively warm patients, employ tranexamic acid or use pelvic restraint belts.