BMJ Open: first published as 10.1136/bmjopen-2017-019627 on 23 January 2018. Downloaded from BMJ Open is committed to open peer review. As part of this commitment we make the peer review history of every article we publish publicly available. Whe a atile is pulished e post the pee eiees’ oets ad the authos’ esposes online. We also post the versions of the paper that were used during peer review. These are the versions that the peer review comments apply to. The versions of the paper that follow are the versions that were submitted during the peer review process. They are not the versions of record or the final published versions. They should not be cited or distributed as the published version of this manuscript. BMJ Open is an open access journal and the full, final, typeset and author-corrected version of record of the manuscript is available on our site with no access controls, subscription charges or pay- per-view fees (http://bmjopen.bmj.com). If you hae ay uestios o BMJ Ope’s ope pee eie poess please eail [email protected] http://bmjopen.bmj.com/ on September 27, 2021 by guest. Protected copyright. BMJ Open: first published as 10.1136/bmjopen-2017-019627 on 23 January 2018. Downloaded from BMJ Open What fluids are given during air ambulance treatment of trauma patients in the UK, and what might this mean for the future? Results from the RESCUER observational cohort study For peer review only Journal: BMJ Open Manuscript ID bmjopen-2017-019627 Article Type: esearch Date Submitted by the Author: 14-Sep-2017 Complete List of Authors: Naumann, David; NI, , Surgical econstruction and Microbiology esearch Centre ,ancox, James; NI, , Surgical econstruction and Microbiology esearch Centre aitt, James; Thames /alley Air Ambulance Smith, Iain; NI, , Surgical econstruction and Microbiology esearch Centre Crombie, Nicholas; NI, , Surgical econstruction and Microbiology esearch Centre http://bmjopen.bmj.com/ Doughty, ,eidi; (,S 0lood and Transplant 1er2ins, 3avin; 4niversity of 5arwic2, 5arwic2 Medical School Midwinter, Mar2; 4niversity of 7ueensland School of 0iomedical Sciences <b91rimary Subject Emergency medicine ,eading8:b9 Secondary Subject ,eading: ,ealth services research, ,ealth informatics, 1ublic health clinical management, prehospital care, helicopter retrieval, emergency on September 27, 2021 by guest. Protected copyright. Keywords: ambulance systems, T A4MA MANA3EMENT, 1rehospital care For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open: first published as 10.1136/bmjopen-2017-019627 on 23 January 2018. Downloaded from Page 1 of 30 BMJ Open 1 2 3 What fluids are given during air ambulance treatment of trauma patients 4 5 in the UK, and what might this mean for the future? Results from the 6 7 RESCUER observational cohort study 8 9 10 David N Naumann1,2, James M Hancox1,3, James Raitt4, Iain M Smith1, Nicholas Crombie1, 11 12 Heidi Doughty5, Gavin Perkins6, Mark J Midwinter2,7, The RESC,ER Colla orators- 13 14 15 ffiliations 16 1 For peer review only 17 NIHR Surgical Reconstruction and Microbiology Research Centre, .ueen Eli/a eth 18 19 Hospital, 1irmingham, ,2 20 2,niversity of 1irmingham, Edg aston, 1irmingham, ,2 21 3 22 4est Midlands Ambulance Service NHS 6oundation Trust, 4est Midlands, Millennium 23 Point, 4aterfront 4ay, 1rierley Hill, 4est Midlands, ,2 24 25 4Thames 7alley Air Ambulance, RA6 1enson, 8xfordshire, ,2 26 5 27 NHS 1lood and Transplant, 1irmingham, ,2 28 6,niversity of 4arwick, Coventry, ,2 29 7 30 School of 1iomedical Sciences, 6aculty of Medicine, ,niversity of .ueensland, 1ris ane, 31 http://bmjopen.bmj.com/ 32 Australia 33 -Colla orating authors and their affiliations are listed elow 34 35 36 Corresponding author 37 38 Dr David N Naumann, NIHR Surgical Reconstruction and Microbiology Research Centre, 39 on September 27, 2021 by guest. Protected copyright. 40 .ueen Eli/a eth Hospital, 1irmingham, ,2, 115 2TH 41 Email9 david.naumann;nhs.net 42 43 Phone9 +44 (0) 7861 242 807 44 45 46 *Collaborating authors (and affiliations in brackets) 47 48 Daniel Evans, Jenny Conway, Caroline Aeech (The Air Am ulance Service, Clifton House, 49 1utlers Aeap, Rug y, 4arwickshire, ,2)B Simon Aewis, Natalie Church (Magpas Air 50 51 Ambulance, Centenary House, St. MaryCs Street, Huntingdon, Cambridgeshire, ,2)B 52 53 Christopher von Mickwit/, Andrew Pountney, 6iona 1ell, Jane Shewan (Dorkshire 54 Ambulance Service NHS Trust, Springhill 2, 1rindley 4ay, 4akefield 41 1usiness Park, 55 56 4akefield, ,2)B Phil Hyde, Michael Eddie, Michelle 4alker (Dorset & Somerset Air 57 58 59 1 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open: first published as 10.1136/bmjopen-2017-019627 on 23 January 2018. Downloaded from BMJ Open Page 2 of 30 1 2 3 Ambulance, Aandacre House, Castle Road, Chelston 1usiness Park, 4ellington, ,2)B 4 Richard Hindson, Alastair 4ilson (East Anglian Air Am ulance, Hangar E, Gam ling Close, 5 6 Norwich Airport, Norwich, ,2)B Stuart Elms, Christina Hood (Essex and Herts Air 7 8 Ambulance, 6light House, Earls Colne 1usiness Centre, Earls Colne 1usiness Park, Earls 9 Colne, Colchester, ,2)B Jules 1lackham, Scott Grier, 7icki 1rown (Great 4estern Air 10 11 Ambulance Charity, County Gates, 3rd 6loor, Ashton Road, 1ristol, ,2)B Richard Irwin, 12 13 Neil Clarke (Aincolnshire E Nottinghamshire Air Ambulance, 1entley Drive, 1race ridge 14 Heath, Aincoln, ,2)B Alasdair Corfield, Anne Cadman (EMRS Scotland, ScotSTAR, Hangar 15 16 1, 180 A otsinchFor Road, Paisley,peer ,2). review only 17 18 19 20 21 22 23 24 25 26 27 28 29 30 http://bmjopen.bmj.com/ 31 32 33 34 35 36 37 38 39 on September 27, 2021 by guest. Protected copyright. 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 2 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open: first published as 10.1136/bmjopen-2017-019627 on 23 January 2018. Downloaded from Page 3 of 30 BMJ Open 1 2 3 BSTR CT 4 5 6 Ob(ectives 7 8 4e investigated how often intravenous fluids have een delivered during physician-led 9 10 prehospital treatment of hypotensive trauma patients in the ,2, and which fluids were given. 11 12 13 These data were used to estimate the potential national reGuirement for prehospital lood 14 15 products (PH1P) if evidence from ongoing trials were to report clinical superiority. 16 For peer review only 17 18 19 Setting 20 21 The Regional Exploration of Standard Care d,ring Evacuation Resuscitation (RESC,ER) 22 23 retrospective observational study was a colla oration etween 11 ,2 air am ulance services. 24 25 26 Each was invited to provide up to 5 years of data, and total num er of taskings during the 27 28 same period. 29 30 31 http://bmjopen.bmj.com/ 32 Participants 33 34 Hypotensive trauma patients (systolic lood pressure HI0mmHg or a sent radial pulse), 35 36 attended y a doctor. 37 38 39 on September 27, 2021 by guest. Protected copyright. 40 41 Primary and secondary outcome measures 42 43 The primary outcome was the number of hypotensive trauma patients given prehospital 44 45 fluids. Secondary outcomes were types and volumes of fluids. These data were com ined 46 47 with published data to estimate potential national eligi ility for PH1P. 48 49 50 51 52 Results 53 54 8f 2I,037 taskings, 72I (2.5%) were for hypotensive trauma patients attended y a physician. 55 56 Half were aged 21K50 yearsB 73.4% were male. 537/72I (73.7%) were given fluids. 510 were 57 58 59 3 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open: first published as 10.1136/bmjopen-2017-019627 on 23 January 2018. Downloaded from BMJ Open Page 4 of 30 1 2 3 given a single type of fluidB 27 received M1 type. The most common fluid was 0.I% saline, 4 5 given to 486/537 (I0.5%) of patients who received fluids, at a median volume of 750 (I.R 6 7 300K1500) ml. 3% of patients received PH1P. Estimated proNections for patients eligi le for 8 9 PH1P at these 11 services and in the whole ,2 were 313 and 7I4 patients per year 10 11 respectively. 12 13 14 15 16 Conclusions For peer review only 17 18 8ne in 40 air am ulance taskings in the ,2 were manned y physicians to retrieve 19 20 hypotensive trauma patients. The most common fluid delivered was 0.I% saline. If evidence 21 22 Nustifies universal provision of PH1P, approximately 800 patients per year would e eligi le 23 24 in the ,2, ased on our data combined with those already published. 25 26 27 28 29 Keywords 30 31 Prehospital careB traumaB emergency ambulance systemsB helicopter retrievalB prehospital http://bmjopen.bmj.com/ 32 33 care, clinical management 34 35 36 37 38 39 on September 27, 2021 by guest. Protected copyright. 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 4 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open: first published as 10.1136/bmjopen-2017-019627 on 23 January 2018. Downloaded from Page 5 of 30 BMJ Open 1 2 3 Strengths and limitations of this study 4 5 6 This study reports data from the largest air ambulance colla oration to date, and 7 8 illustrates the heterogeneity etween air am ulance services in the ,2 with regards to 9 10 provision of prehospital fluids for hypotensive trauma patients.