Opinions of trauma practitioners regarding prehospital interventions for critically injured patients.
BACKGROUND
Significant controversy surrounds the prehospital management of trauma patients.


METHODS
A questionnaire describing clinical scenarios was mailed to a random sample of 345 trauma practitioners.


RESULTS
The 182 trauma practitioners (52.8%) who returned the surveys were predominantly general or trauma surgeons (83.5%) in academic or university practice (68.1%). For a patient with a severe traumatic brain injury, 84.5% of trauma practitioners recommended that emergency medical services personnel attempt intubation at least once when transport time was 20 to 40 minutes. For a patient with a gunshot wound to the epigastrium in decompensated shock, the majority of trauma practitioners believed that a relatively hypotensive state should be maintained, regardless of transport time. Trauma practitioners (52.2%) have recommended the use of the pneumatic antishock garment for transports of 20 to 40 minutes for patients with an unstable pelvic fracture and decompensated shock.


CONCLUSIONS
Most trauma practitioners believe that emergency medical services providers should attempt intubation for a patient with a severe traumatic brain injury, should treat decompensated shock in a patient with penetrating torso trauma but maintain the patient in a relatively hypotensive state, and should apply and inflate the pneumatic antishock garment for a suspected pelvic fracture accompanied by decompensated shock if the patient is 20 to 40 minutes from a trauma center. The recommendations of trauma practitioners regarding appropriate prehospital care are significantly influenced by the time required for transport to the trauma center.
Salomone
Jeffrey P
JP
Department of Surgery, Emory University School of Medicine, Atlanta, Georgia 30303, USA. jsalomo@emory.edu
Ustin
Jeffrey S
JS
McSwain
Norman E
NE
Feliciano
David V
DV
D000328:Adult; D022561:Advanced Cardiac Life Support / Q000379:methods*; D001291:Attitude of Health Personnel; D003413:Cricoid Cartilage / Q000601:surgery; D016638:Critical Illness / Q000628:therapy*; D004632:Emergency Medical Services / Q000379:methods*; D005180:Faculty, Medical / Q000458:organization & administration; D005440:Fluid Therapy / Q000379:methods; D005676:Gravity Suits; D006801:Humans; D007103:Immobilization / Q000379:methods; D007442:Intubation, Intratracheal; D008505:Medical Staff, Hospital / Q000458:organization & administration / Q000523:psychology*; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D009104:Multiple Trauma / Q000628:therapy*; D015999:Multivariate Analysis; D010092:Oximetry; D018579:Patient Selection; D011795:Surveys and Questionnaires; D013997:Time Factors; D014139:Tracheostomy; D014187:Transportation of Patients / Q000379:methods; D014194:Traumatology / Q000379:methods*; D014481:United States