Pre-hospital considerations

The Australian and New Zealand Committee On Resuscitation (ANZCOR) recommends that in the prehospital setting patients in cardiac arrest from trauma should only be transported to hospital after return of spontaneous circulation.1 The exception to this is where the hospital is in such close proximity that the patient may have a realistic chance of having access to a resuscitative thoracotomy (RT) within 10 minutes and the patient had signs of life on paramedic arrival.

Treatment of possibly reversible causes such as external haemorrhage, tension pneumothorax and airway obstruction are within the scope of practice of all Ambulance Victoria paramedics. Mobile Intensive Care Flight paramedics also have the capacity to administer a blood transfusion to the patient in hypovolaemic shock.  

Patients who have a cardiac arrest en-route to hospital should have the above interventions performed with minimal delay.

Transport to an appropriate hospital for immediate interventions including surgical and operating theatre access and blood bank support is essential.

 Ambulance Victoria Traumatic Cardiac Arrest Clinical Practice Guideline