Prehospital time and mortality in polytrauma patients: a retrospective analysis

Abstract Background The time from injury to treatment is considered as one of the major determinants for patient outcome after trauma. Previous studies already attempted to investigate the correlation between prehospital time and trauma patient outcome. However, the outcome for severely injured patients is not clear yet, as little data is available from prehospital systems with both Emergency Medical Services (EMS) and physician staffed Helicopter Emergency Medical Services (HEMS). Therefore, the aim was to investigate the association between prehospital time and mortality in polytrauma patients in a Dutch level I trauma center. Methods A retrospective study was performed using data derived from the Dutch trauma registry of the National Network for Acute Care from Amsterdam UMC location VUmc over a 2-year period. Severely injured polytrauma patients (Injury Severity Score (ISS) ≥ 16), who were treated on-scene by EMS or both EMS and HEMS and transported to our level I trauma center, were included. Patient characteristics, prehospital time, comorbidity, mechanism of injury, type of injury, HEMS assistance, prehospital Glasgow Coma Score and ISS were analyzed using logistic regression analysis. The outcome measure was in-hospital mortality. Results In total, 342 polytrauma patients were included in the analysis. The total mortality rate was 25.7% (n = 88). Similar mean prehospital times were found between the surviving and non-surviving patient groups, 45.3 min (SD 14.4) and 44.9 min (SD 13.2) respectively (p = 0.819). The confounder-adjusted analysis revealed no significant association between prehospital time and mortality (p = 0.156). Conclusion This analysis found no association between prehospital time and mortality in polytrauma patients. Future research is recommended to explore factors of influence on prehospital time and mortality.

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Significance of a Level-2,“Selective, Secondary Evacuation” Hospital during a Peripheral Town Terrorist Attack

Prehospital and Disaster Medicine ◽

10.1017/s1049023x00004350 ◽

2007 ◽

Vol 22 (1) ◽

pp. 59-66 ◽

Cited By ~ 12

Author(s):

Dagan Schwartz ◽

Moshe Pinkert ◽

Adi Leiba ◽

Meir Oren ◽

Jacob Haspel ◽

...

Keyword(s):

Emergency Medical Services ◽

Trauma Center ◽

Mass Casualty ◽

Medical Services ◽

Severely Injured ◽

Medical Response ◽

Emergency Medical ◽

Level 1 ◽

Injured Patients ◽

Level 2

AbstractIntroduction:Mass-casualty incidents (MCIs) can occur outside of major metropolitan areas. In such circumstances, the nearest hospital seldom is a Level-1 Trauma Center. Moreover, emergency medical services (EMS) capabilities in such areas tend to be limited, which may compromise prehospital care and evacuation speed. The objective of this study was to extract lessons learned from the medical response to a terrorist event that occurred in the marketplace of a small Israeli town on 26 October 2005. The lessons pertain to the management of primary and secondary evacuation and the operational practices by the only hospital in the town, which is designated as a Level-2 Trauma Center.Methods:Data were collected during the event by Home Front Command Medical Department personnel. After the event, formal and informal debriefings were conducted with emergency medical services personnel, the hospitals involved, and the Ministry of Health.The medical response components, interactions (mainly primary triage and secondary distribution), and the principal outcomes were analyzed.The event is described according to Disastrous Incidents Systematic Analysis Through Components, Interactions, Results (DISAST-CIR) methodology.Results:The suicide bomber and four victims died at the scene, and two severely injured patients later died in the hospital. A total of 58 wounded persons were evacuated, including eight severely injured, two moderately injured, and 48 mildly injured. Forty-nine of the wounded arrived to the nearby Hillel Yafe Hospital, including all eight of the severely injured victims, the two moderately injured, and 39 of the mildly injured. Most of the mildly injured victims were evacuated in private cars by bystanders.Five other area hospitals were alerted, three of which primarily received the mildly injured victims. Twodistant, Level-1 Trauma Centers also were alerted; each received one severely injured patient from Hillel Yafe Hospital during the secondary distribution process.Emergency medical services personnel were able to treat and evacuate all severely and moderately injured patients within 17 minutes of the explosion. A total of 12 of the 21 ambulances arriving on-scene within the first 20 minutes were staffed by emergency medical services volunteers or off-duty workers.Conclusion:When a mass-casualty incident occurs in a small town that is in the vicinity of a Level-2 Trauma Center, and located a >40 minute drive from Level-1 Trauma Centers, the Level-2 Trauma Center is a critical component in medical management of the event. All severely and moderately injured patients initially should be evacuated to the Level-2 Trauma Center, and given advanced, hospital-based resuscitation. The patients needing care beyond the capabilities of this facility should be distributed secondarily to Level-1 Trauma Centers.To alleviate the burden placed on the local hospital, some of the mildly injured victims can be evacuated primarily to more distant hospitals.The ability to control the flow of mildly injured patients is limitedby the large percentage of them arriving by private cars. The availability of emergency medical services in small towns can be augmented significantly by enrolling off-duty emergency medical services workers and volunteers to the rescue effort. Level-2 hospitals in small towns should be prepared and drilled to operate in a “selective evacuation” mode during mass-casualty incidents.

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Emergency Medical Services Out-of-Hospital Scene and Transport Times and Their Association With Mortality in Trauma Patients Presenting to an Urban Level I Trauma Center

Annals of Emergency Medicine ◽

10.1016/j.annemergmed.2012.08.026 ◽

2013 ◽

Vol 61 (2) ◽

pp. 167-174 ◽

Cited By ~ 73

Author(s):

C. Eric McCoy ◽

Michael Menchine ◽

Sehra Sampson ◽

Craig Anderson ◽

Christopher Kahn

Keyword(s):

Emergency Medical Services ◽

Trauma Center ◽

Medical Services ◽

Trauma Patients ◽

Emergency Medical ◽

Urban Level ◽

Level I

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Association between dispatch complaint and critical prehospital time intervals in suspected stroke 911 activations in the National Emergency Medical Services Information System, 2012–2016

Journal of Stroke and Cerebrovascular Diseases ◽

10.1016/j.jstrokecerebrovasdis.2021.106228 ◽

2022 ◽

Vol 31 (3) ◽

pp. 106228

Author(s):

Amena Y. Abbas ◽

Erika C. Odom ◽

Isaac Nwaise

Keyword(s):

Information System ◽

Emergency Medical Services ◽

Medical Services ◽

Time Intervals ◽

Emergency Medical ◽

Suspected Stroke ◽

National Emergency ◽

Prehospital Time

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The Association of Trauma Center Transport and Long‐term Functional Outcomes in Head‐injured Older Adults Transported by Emergency Medical Services

Academic Emergency Medicine ◽

10.1111/acem.13915 ◽

2020 ◽

Vol 27 (3) ◽

pp. 207-216

Author(s):

Daniel K. Nishijima ◽

Samuel D. Gaona ◽

Mark Faul ◽

Daniel J. Tancredi ◽

Trent Waechter ◽

...

Keyword(s):

Older Adults ◽

Emergency Medical Services ◽

Trauma Center ◽

Functional Outcomes ◽

Medical Services ◽

Emergency Medical ◽

Head Injured

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Beneficial effect of helicopter emergency medical services on survival of severely injured patients

British Journal of Surgery ◽

10.1002/bjs.4756 ◽

2004 ◽

Vol 91 (11) ◽

pp. 1520-1526 ◽

Cited By ~ 85

Author(s):

S. P. G. Frankema ◽

A. N. Ringburg ◽

E. W. Steyerberg ◽

M. J. R. Edwards ◽

I. B. Schipper ◽

...

Keyword(s):

Beneficial Effect ◽

Emergency Medical Services ◽

Medical Services ◽

Severely Injured ◽

Severely Injured Patients ◽

Helicopter Emergency Medical Services ◽

Emergency Medical ◽

Injured Patients

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Patient Outcome Using Medical Protocol to Limit “Lights and Siren” Transport

Prehospital and Disaster Medicine ◽

10.1017/s1049023x00041443 ◽

1994 ◽

Vol 9 (4) ◽

pp. 226-229 ◽

Cited By ~ 26

Author(s):

Douglas F. Kupas ◽

David J. Dula ◽

Bruno J. Pino

Keyword(s):

Patient Outcome ◽

Emergency Department ◽

Emergency Medical Services ◽

Adverse Outcomes ◽

Medical Services ◽

Vehicle Collisions ◽

Patient Transport ◽

Emergency Medical ◽

Warning Lights

AbstractIntroduction:Emergency medical services vehicle collisions (EMVCs) associated with the use of warning “lights and siren” (L&S) are responsible for injuries and death to emergency medical services (EMS) personnel and patients. This study examines patient outcome when medical protocol directs L&S transport.Design:During four months, all EMS calls initiated as an emergency request for service and culminating in transport to an emergency department (ED) were included. Medical criteria determined emergent (L&S) versus non-emergent transport. Patients with worsened conditions, as reported by EMS providers, were reviewed.Setting:Countywide suburban/rural EMS system.Results:Ninety-two percent (1,495 of 1,625) of patients were transported non-emergently. Thirteen (1%) of these were reported to have worsened during transport, and none of them suffered any worsened outcome related to the non-L&S transport.Conclusion:This medical protocol directing the use of warning L&S during patient transport results in infrequent L&S transport. In this study, no adverse outcomes were found related to non-L&S transports.

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Study on patient satisfaction among patients with trauma admitted to trauma centre and emergency medical services ward

International Surgery Journal ◽

10.18203/2349-2902.isj20191070 ◽

2019 ◽

Vol 6 (4) ◽

pp. 1219

Author(s):

Mrutyunjay I. Uppin ◽

Kapildev K. Hannurkar ◽

Archana M. Uppin

Keyword(s):

Patient Satisfaction ◽

Emergency Medical Services ◽

Trauma Center ◽

Road Traffic ◽

Trauma Centre ◽

Medical Services ◽

Research Centre ◽

Trauma Patients ◽

Quality Health Care ◽

Emergency Medical

Background: Patient satisfaction is an important key factor for determining the quality health care and services offered by the emergency departments in the hospital. The objectives of the study were to assess the satisfaction of the trauma patients attending the trauma center with the services provided by the KLES Dr. Prabhakar Kore Hospital and Research Centre, Belagavi, Karnataka.Methods: Fifty trauma patients admitted and treated in trauma center and emergency medical services ward (TCEMS) at KLES Dr. Prabhakar Kore Hospital and Research Centre, Belagavi, over a period of 3 months (from November 2014 till January 2015) were interviewed. After obtaining an informed consent, the required data was collected using a pre-designed and pre-tested questionnaire.Results: Out of the 50 patients interviewed, 86% were males and 14% were females. Out of them 74% were road traffic accident victims. 67.5% of these victims were between the age group of 21 and 50 yrs. The overall satisfaction was good with all the services provided at the center. 80% were satisfied with the care provided by the doctors, 80% with communication by doctors, more than 75% with accessory services, more than 65% with the wait times at various levels and more than 85% satisfaction with amenities in the ward.Conclusions: In conclusion our study revealed that the availability of consultant in triage area, improvements in communication, quick service at the Casualty Pharmacy, reducing the perceived waiting times at various levels and improvement in the ambience of the unit would further enhance the patient satisfaction with TCEMS.

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