Background: The utility of advanced prehospital interventions for severe blunt traumatic brain injury (BTI) remains\r\ncontroversial. Of all trauma patient subgroups it has been anticipated that this patient group would most benefit\r\nfrom advanced prehospital interventions as hypoxia and hypotension have been demonstrated to be associated\r\nwith poor outcomes and these factors may be amenable to prehospital intervention. Supporting evidence is largely\r\nlacking however. In particular the efficacy of early anaesthesia/muscle relaxant assisted intubation has proved\r\ndifficult to substantiate.\r\nMethods: This article describes the design and protocol of the Head Injury Retrieval Trial (HIRT) which is a randomised\r\ncontrolled single centre trial of physician prehospital care (delivering advanced interventions such as rapid sequence\r\nintubation and blood transfusion) in addition to paramedic care for severe blunt TBI compared with paramedic care alone.\r\nResults: Primary endpoint is Glasgow Outcome Scale score at six months post injury. Issues with trial integrity resulting\r\nfrom drop ins from standard care to the treatment arm as the result of policy changes by the local ambulance system are\r\ndiscussed.\r\nConclusion: This randomised controlled trial will contribute to the evaluation of the efficacy of advance prehospital\r\ninterventions in severe blunt TBI.
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