title: Walking between the drops: Israeli defense forces' fluid resuscitation protocol.
abstract: BACKGROUND
  Current research in trauma resuscitation indicates that it is important to strike a balance between withholding intravenous fluid therapy, on one hand, and giving too much, on the other. The Israel Defense Forces' former protocol for prehospital fluid administration in the trauma setting was intended to navigate this balancing act. It turned out that the protocol was not being appropriately implemented in field conditions.
  
  
  OBJECTIVE
  We describe our process improvement, which resulted in our revised protocol. Our goal in drafting the new protocol was to achieve yet another balance, this time between the recommendations derived from accumulating science, and the efficacy with which they could likely be implemented in the field.
  
  
  CONCLUSIONS
  We review the available research in prehospital fluid administration, and then develop our current protocol. Per our a priori requirements, the protocol is unified in that medical personnel from a very wide spectrum of caregivers can apply it; and it is appropriate for both short evacuation time scenarios (e.g., low-intensity conflicts) and lengthier evacuation scenarios (e.g., high-intensity conflicts).
  
  
  CONCLUSIONS
  Survival is likely improved if guidelines do not add unnecessary complexity and are easily implemented. We believe that the current protocol is suitable for the large majority of trauma patients, and helps guide providers toward a primary decision-point regarding fluid administration. Nonetheless, as long as only coarse clinical parameters for identifying shock are available, and data regarding optimal treatment are conflicting, offering truly balanced fluid resuscitation guidelines is a lot like walking between the drops.
authors.affiliation: Medical Corps, Surgeon General's Headquarters, Israel Defense Forces, Israel.
authors.forename: Ari M
authors.initials: AM
authors.lastname: Lipsky
authors.forename: Ori
authors.initials: O
authors.lastname: Ganor
authors.forename: Amir
authors.initials: A
authors.lastname: Abramovich
authors.forename: Udi
authors.initials: U
authors.lastname: Katzenell
authors.forename: Elon
authors.initials: E
authors.lastname: Glassberg
mesh_terms: D002985:Clinical Protocols / Q000592:standards*; D005440:Fluid Therapy / Q000379:methods* / Q000592:standards; D006801:Humans; D007557:Israel; D009104:Multiple Trauma / Q000628:therapy*; D017410:Practice Guidelines as Topic; D012151:Resuscitation / Q000379:methods*