Assessing the Importance of Prehospital Interventions on Shock Index and Patient Outcomes at a Rural Appalachian Level 1 Trauma Center

Prehospital interventions, used individually or in combination, can have better patient outcomes; however, rural areas have limited resources. Shock index (SI) has been found to predict resource utilization, hospital outcomes, and mortality. Reducing SI through utilization of prehospital interventions could benefit patient outcomes. A total of 274 trauma activation patients between January 2017 and March 2024 were brought directly from the scene to a level 1 trauma center with a SI >1.0. Demographics, prehospital interventions (transfusions, tranexamic acid (TXA), and tourniquet use), transportation time, change in SI, and patient outcomes were analyzed. Reducing SI correlated with better patient outcomes (<i>P</i> < 0.05) and combining TXA with blood or TXA with tourniquet reduced SI and LOS (<i>P</i> < 0.05). Optimization of prehospital interventions in rural areas may improve a patient's condition prior to hospital arrival, ultimately benefiting patients and minimizing hospital costs through reduced resource utilization.