Although road accidents form a major part of the accident pie chart, there are still other zones apart from roads where people are accident prone. Workers in factories, fire fighters, miners and virtually all blue collared working force in UK are under constant threat of accidents.
Most of the deaths that result due to accidents have been identified to be due to excessive blood loss, a term, in medical terminology known as hemorrhage. Mainly two types of injuries are identified. In 'Penetrating Injuries', the skin is breached by sharp objects such as a knife and leads to potential internal bleeding. In 'Blunt Injuries', the skin is not deeply penetrated and generally remains unbroken. However the magnitude of the injury damages the internal organs. The bleeding that is caused by these injuries must be controlled. If the bleeding exceeds the normal bounds, it leads to the reduction in blood volume, technically known as 'hypovolaemia'. This may even lead to 'shock' which is a state of circulatory failure. In such a state the perfusion of necessary fluids and blood to vital internal organs is hampered. This consequently leads to multiple organ failure.
Generally the first crew to reach the scene of accident is the ambulance crew. Apart from the driver and attendant in most ambulances also have a paramedic. According to the JRCALC guidelines for pre hospital fluid replacement, only a paramedic can administer fluids on the site to the injured. In an email communication with the authors of 'Clinical Effectiveness and Cost Effectiveness of pre hospital intravenous fluids in trauma patients', trauma.org told that, "All patients would be considered for fluids. (Perhaps not all should receive but currently in the UK almost all will) [The] approximate percentage of trauma patients who receive fluids [is] currently 100%" (Dretzke et al, 2003).
Administration of intravenous fluids on - site is a traditional approach to handle injuries. This method was supported by early animal studies. The theory behind fluid replacement methodology is that, fluid replacement therapy attempts to reverse the effects of excessive blood loss by increasing circulatory blood volume and blood pressure back to the normal levels and maintains the perfusion of vital organs thereby reducing the risk of death from multiple organ failure (NICE, 01/04).
Methodology and Technology
The physiological state of the victim of injury is analyzed by the paramedic to identify which pre - hospital fluids are needed. Certain factors are analyzed such as degree of blood loss and whether the hemorrhage is controlled or uncontrolled. The Technology Appraisal of NHS identifies the other indicators of hemorrhage in adults as tachycardia, peripheral vasoconstriction and reduced blood pressure (NHS, 01/04). The shock levels are categorized according to the severity.
Intravenous fluids are considered on similar lines as medicines, and are broadly classified as crystalloids, colloids, or combination fluids. Combination fluids consist of hypertonic saline with starch or dextran. According to the JRCALC regulations only paramedics may administer crystalloid and colloid solutions. Crystalloids pass through cell membranes into different body fluid compartments, thereby making up for the fluids lost due to