Fight Or Flight: The Pre-Hospital Dilemma

L.J. Relle, BBA, NRP, FP-C, CCP-C
EMS1 Magazine
January 31, 2022

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


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?




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.