Pre-hospital Management of the Critically Injured Patient

Pre hospital management of critically injured patients is challenging but the application of a framework for key decisions can aid management in stressful austere environments. The field is continually evolving and evidence emerging for the use of novel therapies such as Resuscitative Balloon Occlusion of the Aorta (REBOA) for uncompressible lower body haemorrhage. Patients with traumatic cardiac arrest pose a particular challenge but the application of a management framework that includes that early use of focussed echocardiography and aggressive volume resuscitation can produce unexpected survivors from what had previously been considered a universally fatal condition. Resuscitative thoracotomy has been widely adopted by military and civilian healthcare providers and has a role in selected patients. The nature of the pre-hospital retrieval service is of importance and there is evidence that specialist physician delivered care improves outcomes. One such service, the UK military Medical Emergency Response Team (MERT), is described in detail