Zero-time Prehospital IV

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Abstract
Advances in prehospital stabilization and resuscitation of traumatized vicitims continue to have an impact on morbidity and mortality. Certain aspects of Advanced Trauma Life Supoort still remain controversial. Recent reports have questioned the usefulness of IV''s started in the prehospital phase both because of delay in transport and because of the actual or theoretical lack of adequate volume infusion during transport. If IV lines can be started while an accident vicitim is en route to the hospital with no delay in transport, then much of the argument against prehospital IV''s become irrelevant. From October 1985 through November 1986 we prosepctively studied IV access attempts in 350 consecutive patients. Overall IV''s started at the scene were 775 successful (n = 70) and en route 81% (n = 213) of attempts were successful. Of those with BP < 100 mm Hg, there were 66% successful onscene attempts and 72% successful en-route attempts. Protocols for IV administration in non-trapped patients should initiate IV access only en route to the hospital while the ambulance is moving. Even if delay at the scene is minimal, it is not possible to justify an delay, since IV''s can be successfully instituted en route.

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