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Fight or flight: The pre-hospital dilemma

The decision to treat on scene or transport should depend on the training and abilities of the responders, not on the equipment at hand


The choice to provide on-scene care or rush to local care facilities begs the question: what if clinicians had the proper tools to deliver on-scene care, reducing the need to rapidly transport patients and maximizing treatment potential?


When EMS clinicians arrive at an emergency, they must quickly assess the situation at hand and make immediate medical decisions to effectively care for patients in need. Under pressure to provide the right care at the right time, EMS clinicians may opt to transport patients to nearby medical facilities rather than deliver on-scene care. While effective, this approach costs patients valuable time, which in certain situations can mean life, death or severe health repercussions.

This choice, to provide on-scene care or rush to local care facilities, begs the question: what if clinicians had the proper tools to deliver on-scene care, reducing the need to rapidly transport patients and maximizing treatment potential?

Importance of on-scene pre-hospital care

On-scene medical treatment is crucial for patient care, the results of which can be pivotal for positive patient outcomes. A recent peer reviewed study found that out-of-hospital cardiac arrest (OHCA) patient hypotension on hospital arrival was reduced when EMS professionals provided intravenous adrenaline and fluids to maintain post-resuscitation standard systolic blood pressure. When OHCA patients with an initial shockable rhythm did not receive infusions on-site, they were associated with lower odds of survival to hospital discharge.

An additional study showed that among cardiac arrest patients who experienced a return of spontaneous circulation after out-of-hospital cardiac arrest, post-ROSC hypotension was an independent predictor of survival. Those who were cared for in the early hours after ROSC experienced higher survival rates, illustrating the importance of on-site emergency care.

A review of statistical data from the National Emergency Medical Services Information System (NEMSIS) shows that prehospital clinicians care for patients for substantial amounts of time both on scene and in transport. In the analysis (see below), even in suburban and urban environments, average scene times for cardiac arrest lasts 24-34 minutes and transport times range from 8-12 minutes for some of our sickest patients. There is no such thing as a “2-minute run” to the hospital.

These studies demonstrate the power that on-scene care can have on influencing positive patient outcomes. For EMS clinicians to treat patients effectively when they arrive on scene, they require medical-grade equipment designed and built for emergency scenarios, such as mobile ECG monitors and defibrillators, ventilators and IV infusion pumps.

Enabling hospital-grade care prior to hospital arrival

Unfortunately, paramedics today can still be found using “gravity-powered” manual infusion therapy devices. These devices need to be held in an elevated, upright position to function, limiting a paramedic’s ability to operate in unforgiving, on-the-go scenarios. These devices are also difficult to maneuver when transitioning patients from the ambulance to a medical center or when maneuvering through tough terrain.

Advanced IV infusion devices put hospital-grade infusion power directly into EMS clinicians’ hands. Being compact and mobile-ready, these devices allow paramedics to deliver top-notch care to patients both on-scene and during transport to appropriate hospitals – truly the best of both worlds. As such, these pumps are built to withstand turbulent pre-hospital environments, including ambulances or emergency response helicopters.

Additionally, with paramedics making multiple life-depending medical decisions at every EMS emergency, they require devices that take the decision-making burden off their shoulders. Today’s smart infusion pumps come with built-in drug libraries and dose error reduction software, allowing paramedics to provide infusions quickly, and safely to patients. Other capabilities include data monitoring systems, designated field maintenance software and a longer battery life – vital features for the pre-hospital environment.

Making medical decisions easier

An EMS clinician’s fight-or-flight decision to provide immediate care or rush to the nearest facility is a challenging one, the outcome of which varies between each emergency scenario. It is critical that the decision to transport patients depend on the training and abilities of the responding EMS team and not on the readiness of the equipment at hand.

With the proper equipment, EMS clinicians will have the confidence to deliver hospital-grade care on-scene, utilizing the time they have with each patient to the fullest, providing advanced resuscitation without delay. Only with advanced medical devices will paramedics be able to fight against delaying care until arrival at the hospital.

Read the full statistical data analysis from NEMSIS below:

Clemson Ambulance Medication Container.JPG

Read next:

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Examining the types of medical errors prehospital providers are susceptible to, the contributing factors and how infusion pumps can safeguard against medication errors

L.J. Relle is a career firefighter and paramedic who has served the greater New Orleans area for more than 15 years. He has performed various roles in high-volume fire/EMS/critical care agencies and is a veteran of Hurricane Katrina and many other industrial and natural disasters. He also serves as a consultant to Eitan Medical, a global leader in advanced infusion therapy solutions across the care continuum, developing EMS-optimized infusion solutions.