Question: with regards to the Trauma Cardiac Arrest Medical Directive, do you support the placement of a pelvic binder on the patient assuming severe blunt trauma? I understand that under the Blunt/Penetrating Injury Standard in the BLS it is stated: "if the patient has a pelvic fracture, attempt to stabilize the clinically unstable pelvis with a circumferential sheet wrap or a commercial device". Furthering this thought, the Intravenous and Fluid Therapy Medical Directive found within the ALS PCS now states: "An intravenous fluid bolus may be considered for a patient who does not meet trauma TOR criteria, where it does not delay transport and should not be prioritized over management of other reversible causes." Thinking about this all together has me wondering that if a patient who is VSA secondary to severe trauma is eligible to receive an IV bolus to presumably treat hypovolemic shock, would the use of a pelvic binder be supported in the same way? If so, when would be the recommendation to apply a pelvic binder when treating under the Trauma Cardiac Arrest Medical Directive? Thank you.

Thank you for your attentive question.

With regards to pelvic binding in traumatic cardiac arrest, per the BLS-PCS, a clinically unstable pelvis is when you should place a circumferential sheet wrap or commercial device.  If required, improved pelvic stability should be obtained as early as possible (pre-hospital setting without transport delay, or hospital setting).

The emphasis on not delaying transport is also written into the most recent change regarding IV Fluid bolus management in the ALS-PCS Traumatic Cardiac Arrest Medical Directive.  The change was the removal of the statement, Fluid bolus is not listed in the directive and is not indicated.  The rationale, as detailed in the OBHG Companion Document Summary of Changes document (here) is that, An intravenous fluid bolus may be considered for a patient who does not meet Trauma TOR criteria, where it does not delay transport and should not be prioritized over management of other reversible causes.

The bottom line is that rapid transport to the emergency department is of paramount importance when treating patients with cardiac arrest due to trauma.  Make sure to (1) minimize treatment to only known reversible causes (i.e. pelvic binding only when pelvic fracture is suspected with a clinically unstable fracture), and (2) not delay transport to initiate an IV fluid bolus.

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Traumatic Cardiac Arrest

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