Pre-Hospital Initiation of Fluid Replacement Therapy in Trauma (TA74)

Technology Appraisal Guidance No. 74

Source: National Institute for Health and Care Excellence

1. Guidance

This guidance covers the management of adults, children and infants with physical injuries as a result of trauma, in whom there is evidence of obvious or probable blood loss. It does not cover the management of isolated closed head injury. For the purpose of this guidance, it is assumed that basic life support and ongoing assessment of the trauma victim are taking place as appropriate. The requirement for cannulation is considered only within the context of pre-hospital intravenous fluid (IV fluid) administration.

1.1 It is recommended that in the pre-hospital management of adults and older children, IV fluid should not be administered if a radial pulse can be felt (or, for penetrating torso injuries, if a central pulse can be felt).

1.2 In the absence of a radial pulse (or a central pulse for penetrating torso injuries) in adults and older children, it is recommended that IV fluid should be administered in boluses of no more than 250 ml. The patient should then be reassessed, and the process repeated until a radial pulse (or central pulse for penetrating torso injuries) is palpable.

1.3 The administration of IV fluid should not delay transportation to hospital, but when given in accordance with 1.2 above, consideration should be given to administration en route to hospital.

1.4 It is recommended that when IV fluid is indicated in the pre-hospital setting, crystalloid solutions should be the routine choice.

1.5 There is inadequate evidence on which the Institute can base recommendations on when pre-hospital use of IV fluid in young children and infants following trauma is appropriate, or on the volumes of fluid to use. However, there is a broad consensus that transfer to hospital should not be delayed by attempts to administer IV fluid.

1.6 It is recommended that only healthcare professionals who have been appropriately trained in advanced life-support techniques and pre-hospital care should administer IV fluid therapy to trauma patients in the pre-hospital setting.

1.7 Training programmes for healthcare professionals should incorporate the above recommendations.

The guidance shown above constitutes Section 1 of the full document. A copy of the full document and a summary of the evidence is available on the Internet at

Copies of the document can also be obtained by contacting 0845 003 7783 or emailing and quoting reference number N0430. 

This guidance represents the view of the Institute which was arrived at after careful consideration of the available evidence. Health professionals are expected to fully take it into account when exercising their clinical judgement. This guidance does not, however, override the individual responsibility of health professionals to make appropriate decisions in the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.

© Copyright National Institute for Health and Care Excellence. All rights reserved. This material may be freely reproduced for educational and not for profit purposes within the NHS. No reproduction by or for commercial organisations is permitted without the express written permission of the Institute.

Enquiries concerning the guidance should be addressed to: National Institute for Health and Care Excellence, MidCity Place, 71 High Holborn, London WC1V 6NA. email:

Pre-Hospital Initiation of Fluid Replacement Therapy in Trauma.
Issue Date: January 2004
Review Date: January 2007

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