Prehospital antibiotic administration for suspected open fractures: importance and implementation

The recent American College of Surgeons Committee on Trauma (COT), the Orthopedic Trauma Association (OTA), the American College of Emergency Physicians (ACEP), the National Association of EMS Physicians (NAEMSP), and the National Association of Emergency Medical Technicians (NAEMT) joint position statement entitled ‘Prehospital Antibiotic Administration for Suspected Open Fractures’ emphasizes the importance of prehospital antibiotics to help minimize and mitigate fracture-related infection.1 Deep infections after open fractures underscore this urgency, with infection rates as high as 27% for severe open tibia fractures, with multiple factors contributing to this risk, including degree of contamination, injury severity, and delayed treatment.2 The sequela of these infections can have multiple significant patient impacts, lead to prolonged hospitalization, necessitate additional operations, and ultimately affect long-term functional recovery. Early antibiotic administration (ideally within the first hour after injury) has been shown to help prevent serious complications and improve outcomes.3