Prehospital advanced life support vs "scoop and run" in trauma management.

The question of attempted field stabilization versus the "scoop and run" approach in the management of trauma has no clear-cut answer. We have long been supporting a complex EMS system based on a hope for its effectiveness, rather than concrete proof. The data we need are not currently available. To make any scientific conclusions, we must have data generated from well-controlled, prospective, randomized studies. This involves a question of ethics. There exists a strong general feeling that randomizing prehospital care is unethical. We have reached a point where full resuscitative effort at the scene is not only expected by the general public, but anything less is considered inadequate by much of the medical community. Nevertheless, because the true influence of prehospital treatment is unknown, shouldn't the patient also be given the benefit of not receiving on-site stabilization effort in view of its potential harm? Prospective randomized studies undoubtedly will invite criticism. However, this is the only way to generate any meaningful conclusions. The essential questions remain unanswered. Can criticality be reliably assessed in the field, and if so, will advanced life support serve to reduce this criticality, or only further delay appropriate care?