REAPPRAISING THE PREHOSPITAL CARE OF THE PATIENT WITH MAJOR TRAUMA

Recent research efforts have demonstrated that many long-standing prac tices for the prehospital resuscitation of trauma patients may be inap propriate, particularly in certain circumstances. Traditional practice s, such as application of antishock garments and IV fluid administrati on, may even be detrimental in certain patients with uncontrolled blee ding. Endotracheal intubation, although potentially capable of prolong ing a patient's ability to tolerate circulatory arrest, may be harmful if overzealous ventilation further compromises cardiac output in such severe hemodynamic instability. If these procedures delay patient tra nsport, any benefit they may offer could be outweighed by delaying def initive care. To improve current systems of trauma care, future trauma research must address the different mechanisms of injury, the anatomi c areas involved, and the physiologic staging in a given patient.