Prehospital Trauma Compendium: Fluid Resuscitation in Trauma – a Position Statement and Resource Document of NAEMSP

Fluid resuscitation choices in prehospital trauma care are limited, with most Emergency Medical Services (EMS) agencies only having access to crystalloids. Which solution to use, how much to administer, and judging the individual risks and benefits of giving or withholding fluids remains an area of uncertainty. To address the role of crystalloid fluids in prehospital trauma care, we reviewed the available relevant literature and developed recommendations to guide clinical care. The topic of prehospital blood product administration is covered elsewhere.NAEMSP recommends Isotonic crystalloid solutions should be the preferred fluids for use in prehospital trauma management. Specific choice of isotonic crystalloid solutions may be driven by medication compatibility and other operational issues. Permissive hypotension is reasonable in patients without traumatic brain injury (TBI). Avoiding or correcting hypotension in polytrauma patients with TBI may be a higher priority than restricting fluid use. Large volume crystalloid resuscitation should be generally avoided. Developing processes to administer warmed intravenous (IV) fluids is reasonable. Risks of IV fluid use, or restriction, in trauma resuscitation should be weighed against possible benefits. Strategies to reduce the need for IV fluids should be considered. A standard trauma resuscitation curriculum for prehospital providers should be developed to improve evidence-based delivery of IV fluids in trauma.