Discussion: Compared to untrained persons, there is evidence that trained first-aid providers are associated with increased survival from trauma, shorter length of hospitalization after burns, prevention of further burn injuries, and stroke recognition.

Recommendation: Education and training in first aid should be undertaken to improve outcomes after injury and illness. This is a weak recommendation based on low-quality evidence.

Note from Dr. Stopyra: This recommendation suggests that ancillary ED personnel (greeters, security officers, registration personnel) should be trained in first aid. It also tells us that we should take the lead when we encounter the ill or injured outside of the hospital.

Exertional Dehydration (FA 584)

Recommendation Author: Jessica A. Stanich, MD

Dr. Stanich is a member of the emergency medicine residency training class of 2017 at the Mayo School of Graduate Medical Education/Mayo Clinic.

Question: Among adults and children with exertion-related dehydration (P), does drinking oral carbohydrate-electrolyte liquids (I) compared with drinking water (C) change volume/hydration status, vital signs, development of hyperthermia, development of hyponatremia, need for advanced medical care, blood glucose, or patient satisfaction (O)?

Results: Of 1,751 citations initially identified, 12 studies comparing carbohydrate-electrolyte (CE) liquids with water were included in the final analysis. Studies were rated very low quality to moderate quality and downgraded based upon risk of bias and imprecision.

Outcomes: For the critical outcome of volume/hydration status, results suggested that 3% to 8% CE solutions were superior to water for the rehydration of individuals with simple exercise-induced dehydration, although results were mixed. No difference in core temperature was noted after hydration with 5% to 8% CE solutions versus water. No difference in patient satisfaction, based upon nausea or stomach upset scores, was noted between 3% to 8% CE solutions and water. Additionally, 5% to 8% CE solutions were associated with increased serum sodium two to four hours after hydration. No studies evaluated the important outcomes of blood glucose and need for advanced medical care.

Discussion: First-aid providers must recognize signs and symptoms of dehydration and initiate fluid resuscitation when appropriate. The presence or absence of thirst is a poor surrogate for need for rehydration. Available studies demonstrated conflicting results for the primary outcome of rehydration and limited to no information on critical secondary outcomes.

Recommendations: For simple exertion-related dehydration, 3% to 8% CE therapy is the preferred treatment. Acceptable alternatives include water, 12% CE solution, coconut water, 2% milk, tea, tea-CE, or caffeinated tea beverages (weak recommendation, very-low-quality evidence).