Patients with penetrating trauma to the torso should be transported immediately to the nearest trauma center and transport should not be delayed in order to provide on-scene care. This is because life-threatening injuries from penetrating trauma to the torso can truly only be treated in an operating room and nothing we do in the field (or even in the emergency department, for that matter) is likely to improve their outcome. However, for all other trauma patients, especially patients with possible head injury, optimizing their hemodynamics and oxygenation/ventilation in the first 5-10 minutes after injury can really improve their long-term outcomes. For these patients it is preferrable to take the time on scene to get an 18G IV, provide a fluid bolus if indicated, and provide supplemental O2 with goal O2 saturation of 100%.
