settings remains undefined. The subject remains controversial, with several studies providing mixed messages [45, 56,98–100,105–108].
Protocol
A treatment protocol for treating shock in the field should address the following factors:
1 Performing the initial assessment.
2 The definitive or life‐saving interventions appropriate for these patients.
3 Access to definitive care without unnecessary prehospital delay.
4 Resources to be used in the field.
5 Skills of the various levels of EMS clinicians in the field.
Protocols developed for the out‐of‐hospital treatment of shock must consider the heterogeneity of the disease state, the limited assessment and treatment options, and the environment in which the protocols will be applied. Protocols for the inner city may not be appropriate for the rural setting. The level of training and clinical experience of the EMS personnel must also be considered. Ideally, the EMS medical director should use evidence‐based medical decision making, drawing from best practices when developing treatment protocols.
Conclusion
Shock must be correlated with the patient’s clinical condition, age, size, and present and past medical history. EMS clinicians must identify signs of decreased tissue perfusion when assessing for the presence of shock. Treatment modalities for shock are limited in the field, but include bleeding control, fluid administration, inotropic agents, and careful control of assisted ventilation. Although the mainstay of shock treatment is IV fluids, approaches should be individualized for different clinical scenarios. The potential benefits of shock care interventions must be weighed against the potential risks of delaying definitive care.
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