NCEPOD: Trauma - Who Cares? - London Health Programmes

CHAPTER 4 - Prehospital careIn 40/504 (7.9%) cases the pulse was not recorded. Bloodpressure was recorded in 398/504 (78.9%) cases. 21/504(4.2%) patients did not have any measurements of theircardiovascular status recorded prior to arrival at hospital.Measurement of blood pressure at the site of incident or enroute, is not recommended particularly in children, as it maylead to unnecessary delay.Fluid therapy was recorded as being administered either atthe scene or en route in 188/504 cases.Table 35. Appropriate haemorrhage control(advisors’ opinion)Number of patients %Yes 356 96.7No 12 3.3Subtotal 368Insuffi cient data 136Total 504Table 36. Appropriate fluid therapy(advisors’ opinion)Number of patients %Yes 279 87.2No 41 12.8Subtotal 320Insuffi cient data 184Total 504The advisors assessed that in 12 cases, insuffi cient stepshad been taken to control haemorrhage (Table 35), and in41 cases fl uids were not administered appropriately (Table36). In most cases this was because inadequate volumes,or in some cases no fl uid, was administered, despite clinicalfeatures of shock. However, there were no cases in whichthe advisors believed that children under the age of 16 yearshad received inappropriate fl uid resuscitation prehospital.Head injuryIn 25 cases the Glasgow Coma Score (GCS) or AVPU (Alert,Verbal, Pain, Unresponsive) score was not recordedFigure 12. Prehospital Glasgow Coma Score (GCS)140120Number of patients10080604020015 14 13 12 11 10 09 08 07 06 05 04 03Glasgow Coma Score46