Answer:
Thank you for your attentive question.
With regards to pelvic binding in traumatic cardiac arrest, per the BLS-PCS, “a clinically unstable pelvis” is when you should place a circumferential sheet wrap or commercial device. If required, improved pelvic stability should be obtained as early as possible (pre-hospital setting without transport delay, or hospital setting).
The emphasis on not delaying transport is also written into the most recent change regarding IV Fluid bolus management in the ALS-PCS Traumatic Cardiac Arrest Medical Directive. The change was the removal of the statement, “Fluid bolus is not listed in the directive and is not indicated.” The rationale, as detailed in the OBHG Companion Document Summary of Changes document (here) is that, “An intravenous fluid bolus may be considered for a patient who does not meet Trauma TOR criteria, where it does not delay transport and should not be prioritized over management of other reversible causes.”
The bottom line is that rapid transport to the emergency department is of paramount importance when treating patients with cardiac arrest due to trauma. Make sure to (1) minimize treatment to only known reversible causes (i.e. pelvic binding only when pelvic fracture is suspected with a clinically unstable fracture), and (2) not delay transport to initiate an IV fluid bolus.