The use of fluids prehospital has always been, and will likely continue to be a controversial topic. The simple notion that we should be replacing the fluids which have been lost is sensible and logical, but not necessarily logistical. The logistics of carrying blood products make it unfeasible for many services, and certainly on a large scale for widespread use within an ambulance service.
The use of crystalloids has become the mainstay of treatment for most ambulance services. The crystalloid v colloid debate will inevitably rage on. There has been increasing interest in hypertonic saline in traumatic brain injury but it is difficult to tease out benefits, due to the heterogeneity amongst trials. There has been interest in the resuscitation of hypotensive, brain injured patients using “small volume resuscitation” – the use of relatively small volumes of hypertonic solutions to draw interstitial and intracellular fluids back into the intravascular space, e.g.
Prehospital Hypertonic Saline Resuscitation of Patients With Hypotension and Severe Traumatic Brain Injury:A Randomized Controlled Trial