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Background: The traditional sequence of trauma care: Airway, Breathing, Circulation (ABC) has been practiced for many years. It became the standard of care despite the lack of scientific evidence. We hypothesized that patients in hypovolemic shock would have comparable outcomes with initiation of bleeding treatment (transfusion) prior to intubation (CAB), compared to those patients treated with the traditional ABC sequence., Methods: This study was sponsored by the American Association for the Surgery of Trauma multicenter trials committee. We performed a retrospective analysis of all patients that presented to trauma centers with presumptive hypovolemic shock indicated by pre-hospital or emergency department hypotension and need for intubation from January 1, 2014 to July 1, 2016. Data collected included demographics, timing of intubation, vital signs before and after intubation, timing of the blood transfusion initiation related to intubation, and outcomes., Results: From 440 patients that met inclusion criteria, 245 (55.7%) received intravenous blood product resuscitation first (CAB), and 195 (44.3%) were intubated before any resuscitation was started (ABC). There was no difference in ISS, mechanism, or comorbidities. Those intubated prior to receiving transfusion had a lower GCS than those with transfusion initiation prior to intubation (ABC: 4, CAB:9, p  = 0.005). Although mortality was high in both groups, there was no statistically significant difference (CAB 47% and ABC 50%). In multivariate analysis, initial SBP and initial GCS were the only independent predictors of death., Conclusion: The current study highlights that many trauma centers are already initiating circulation first prior to intubation when treating hypovolemic shock (CAB), even in patients with a low GCS. This practice was not associated with an increased mortality. Further prospective investigation is warranted., Trial Registration: IRB approval number: HM20006627. Retrospective trial not registered., Competing Interests: This is a retrospective trial. All centers obtained permission form their own ethics committee. Virginia Commonwealth University IRB approval under protocol number HM20006627.All authors read the final manuscript and consented and agreed to its publication. Since this is a retrospective trial, consent was not necessary to be obtained from patients to review the identified data.The authors’ declare no competing interests with the current work.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Background: Representing 2 % of the general population, American Indians/Alaska Natives (AIs/ANs) were associated with 0.5 % (63) of the estimated 12,500 new cases of spinal cord injury (SCI) reported to the National Spinal Cord Injury Statistic Center in 2013. To date, the trend in health care disparities among AIs/ANs in the SCI community has not been examined. We sought to compare the rate of discharge to rehabilitation facilities (DRF) following traumatic SCI among adult AIs/ANs to other racial/ethnic groups for patients 15 to 64 years old., Methods: Utilizing data from the National Trauma Data Bank (NTDB), we performed a retrospective analysis of SCI cases occurring between January 1, 2008 and December 31, 2012. SCI injuries were identified by International Classification of Diseases 9th Revision-Clinical Modification (ICD-9) codes or Abbreviated Injury Scale (AIS) scores. Injury severity was determined using the Trauma Mortality Prediction Model (TMPM) which empirically estimates each patient's probability of death given their individual complement of injuries. A series of seven logistic regression models were used to predict DRF between racial groups., Results: Among the 29,443 patients in our cohort, 52.4 % were discharged to rehabilitation facilities. AIs/ANs comprised 1.1 % of the population, with 63.8 % dismissed to rehabilitation. AIs/ANs were significantly younger, had a higher probability of death, had longer hospital length of stay (HLOS), and were proportionately more likely to be discharged to rehabilitation compared to non-AIs. Regression models demonstrated increased odds of DRF for AIs/ANs compared to Hispanic and Asian racial/ethnic groups., Conclusions: American Indians/Alaska Natives who sustain SCI access rehabilitative care at a rate equitable to or greater than other races when multiple factors are taken into account. Further research is needed to assess the effect of those patient, physician, and health care system determinants as they relate to a patient's ability to access post-trauma rehabilitative care. Recommendations include advancing the level of racial, insurance, and geographic data necessary to adequately explore disparities related to such ubiquitously life-altering conditions as SCI.