The role of prehospital resuscitation has evolved from the early days of Napoleon’s army in which the wounded were evacuated to aid stations on horse drawn carriages. Before that, soldiers often died in the field before having received any kind of medical care. Modern American Emergency Medical Services (EMS) developed with the return of military veterans from the Vietnam War. Trained medical providers brought previously unavailable care to patients before arrival in hospital. In recent years the development of technology, training, and resource allocation to early trauma care has provided the potential for another period of growth for prehospital resuscitation. As data from recent conflicts are analyzed, a refined understanding of the pathophysiology of shock may facilitate delivery of critical care–level resuscitation in the field. A recent analysis found that critical care procedures were performed frequently on patients transported in Operation Enduring Freedom/Afghanistan.1 In addition, biomarkers for resuscitation and coagulation in troops transported from the point of injury were deranged very early after injury. A critical care–capable transportation platform that “brings the trauma bay to the patient” may offer a therapeutic advantage in carefully selected patients.
Potential benefits must be balanced against the significant resources necessary to dispatch advanced (and expensive) medical care to the scene. This manuscript attempts to define the current issues. A thoughtful solution will require an open-minded dialog between key professional groups. It may be that if one suffers an acute medical event on the steps of the proverbial large metropolitan medical center, then there is little benefit to be gained from advanced prehospital care. If conversely, one suffers an acute injury/illness outside the traditional critical care infrastructure, then prehospital providers can extend access to life-saving medical therapies.