Highlights:
• Study #1 “Faster Refill in an urban emergency medical services system saves lives: A prospective preliminary evaluation of a prehospital advanced resuscitative care bundle” – first study ever to show mortality reduction through blood delivery in urban EMS for penetrating trauma with hemorrhagic shock
• Study #2 “Every Minute Matters: Improving outcome for penetrating trauma through prehospital advanced resuscitative care” – from the moment of EMS arrival until first drop of blood, every minute of delay results in 11% increased mortality
• Study #3 “Impact of Prehospital Exsanguinating Airway-Breathing-Circulation Resuscitation Sequence on Patients with Severe Hemorrhage” – intubation prior to effective resuscitation with blood results in 47% mortality vs 13% for those who received blood first, which means that intubation prior to effective resuscitation with blood results in much higher mortality
All of these studies were based on comparing patients who received the New Orleans EMS “Advanced Resuscitative Care” bundle to the patient with similar injury pattern and blood pressure from the the 3 years prior to implementing the ARC bundle.
New Orleans EMS Advanced Resuscitative Care protocol:
Inclusion Criteria:
• Patients > 5yo with shock due to hemorrhage
• Shock defined by one of the following:
– SBP <70
– SBP <90 with HR ≥110
– <10yo SBP 70 + (2 x age)
ARC bundle components:
• Up to 2U PRBC’s with rapid infuser
• 2G Calcium Chloride
• 2G TXA
AAST presentation in Sept 2023: view here
ref: MK-00157 Rev A