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Standing Orders for Field Intravenous Lines Do Not Shorten Prehospital Time in Trauma Patients

Published online by Cambridge University Press:  28 June 2012

Bartholomew J. Tortella ,
Robert F. Lavery ,
Ronald P. Cody  and
Mindi Salant
Bartholomew J. Tortella*
Affiliation:
Section of Trauma Surgery, Department of Surgery, University of Medicineand Dentistry of New Jersey, The New Jersey Trauma Center and University Hospital, Newark, N.J. Department of Trauma and Emergency Medical Services, University Hospital, Newark, N.J.
Robert F. Lavery
Affiliation:
Section of Trauma Surgery, Department of Surgery, University of Medicineand Dentistry of New Jersey, The New Jersey Trauma Center and University Hospital, Newark, N.J. Department of Trauma and Emergency Medical Services, University Hospital, Newark, N.J.
Ronald P. Cody
Affiliation:
Department of Environmental and Community Medicine, Robert Wood Johnson Medical School—UMDNJ, Piscataway, N.J.
Mindi Salant
Affiliation:
Section of Trauma Surgery, Department of Surgery, University of Medicineand Dentistry of New Jersey, The New Jersey Trauma Center and University Hospital, Newark, N.J. Department of Trauma and Emergency Medical Services, University Hospital, Newark, N.J. Deceased
*
University Hospital, Rm. J-200, 150 Bergen Street, Newark, NJ 07103-2406USA
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Abstract

Study Objective:

No randomized, prospective studies have been conducted that examine how standing orders for establishing intravenous (IV) lines in trauma patients affect prehospital time. The purpose of this randomized, prospective study was to determine if standing orders for IV lines in the field shorten prehospital time.

Design:

A prospective, randomized study was conducted.

Setting:

Trauma patients (n = 521) were randomized prospectively on an even-/odd-day basis over a one-year period from 1 April 1988 to 1 April 1989. Patients were sorted into an IV Standing Orders (SO) arm (n = 258) and a No Standing Orders (NO) arm (n = 263) in which On-Line [Direct] Medical Command (OLMC) was required before IV initiation.

Participants:

Trauma patients, paramedics in a high-volume, urban, EMS system, and medical-command physicians on the trauma team at a Level 1 trauma center.

Results:

No significant differences were found in demographics, prehospital vital signs, mechanism of injury, or trauma severity scores between the two treatment arms. Scene times were similar for the two groups (IV SO = 11.4 minutes, and NO = 10.6 minutes, p = .1675) as was IV success rate (92% vs. 88%, p = .1729).

Conclusion:

When compared to OLMC in this EMS system, IV standing orders did not affect scene time. This supports the concept that only spinal stabilization and airway management be performed at the scene and other ALS maneuvers (e.g., IVs) be performed in the ambulance, preferably en route to a Trauma Center. Since IV standing orders had no documented, adverse effects and led to focused, concise radio telemetry reports, this EMS system adopted their use on a permanent basis.

Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 7 , Issue 3 , September 1992 , pp. 271 - 276
Copyright
Copyright © World Association for Disaster and Emergency Medicine 1992

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Footnotes

Presented at the annual meeting of the Eastern Association for the Surgery of Trauma, 17 January 1991.

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