Emergency Rectal Hydration in Remote Environments

In the 1990’s Camelbak’s moto was “Hydrate or Die!” and they weren’t wrong. Proper hydration is fundamental to life and an important component in both the emergency and long term treatment of the casualty but getting some casualties to drink water is either not possible or, in some casualties, not advised. Frustratingly, these are often the casualties who need hydrating the most:

Unconscious

How do we hydrate, or rehydrate, an unconscious casualty?

Nausea

Casualties suffering from Heat Illness are in desperate need of rehydration but the symptomatic nausea of their condition may mean that they cannot keep fluids down.

Shock

A casualty in hypovolaemic shock needs fluids but should not be given anything to drink as activation of the digestive system will redistribute blood towards it, away from the vital organs.

The experienced clinician will be able to provide fluids either intravenously (IV) or increasingly intraosseosly (IO) and on some ‘medic’ courses you may be shown IV or IO infusion techniques. This is an advanced skill and typically shown to candidates to enable them to support a more experienced medic in the familiarisation and setting up of equipment rather than promoting individuals to administer fluids by these routes under their own initiative.

But what about the medic untrained in these techniques or without the equipment and fluids?

Proctoclysis – rectal rehydration

Rectal infusion (proctoclysis) was effectively employed as an emergency treatment during the First World War for combat casualties and routinely used for infusion in clinical settings before the development of IV techniques and equipment rendered the technique redundant.(1) Early studies demonstrated the colon can retain up to 500mls of fluids per hour (2). In 2005 a now often cited article described an occasion where improvised proctoclysis in a remote setting was effectively used to treat and initially stabilise a casualty in a remote setting, re-igniting discussion on this technique as an emergency treatment in a remote environment. (3)

Rectal Rehydration can provide a simple, safe and effective means to rehydrate a casualty who is unconscious or nauseous and with less risk of adversely affecting their haemodynamic balance. The technique requires neither sterile fluids, special equipment or specific training (4-7)

Proctoclysis may be of benefit for those who work in developing countries or rural areas, where there can be little access to hospital care or where sterile cannula, fluids and giving sets are expensive. It could also be useful in mass casualty situations where clinical teams must administer fluid resuscitation despite having insufficient intravenous equipment or nursing staff. (8) The primary aim of proctoclysis in such emergency situations is to provide initial fluid resuscitation in advance of rapid evacuation for further care in a dedicated medical facility. (3)

Equipment

The 2005 article explains the improved use of a Foley catheter for rectal infusion. This is specialist piece of equipment and unlikely to be found in any First Aid kit, what the remote medic might have at their disposal is a Camelbak style hydration system and tape. A couple of other simple, small and cheap items make the following process a little easier and more effective.

Camelbak style hydration system. Theirs, not yours.

Water-based lubricant

1 Ltr clean water

Tape

Oral Rehydration Solution

Sheets / blankets

Preparation: