Zero-time prehospital i.v

Advances in prehospital stabilization and resuscitation of traumatized victims continue to have an impact on morbidity and mortality. Certain aspects of Advanced Trauma Life Support 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 victim is en route to the hospital with no delay in transport, then much of the argument against prehospital IV's becomes irrelevant. From October 1985 through November 1986 we prospectively studied IV access attempts in 350 consecutive patients. Overall IV's started at the scene were 77% successful (n = 70) and en route 81% (n = 213) of attempts were successful. Of those with BP less than 100 mm Hg, there were 66% successful on-scene 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 any delay, since IV's can be successfully instituted en route.