Decreased mortality after prehospital interventions in severely injured trauma patients.
The journal of trauma and acute care surgery · 2015-07-29 · Observational study
Abstract
BACKGROUND: We test the hypothesis that prehospital interventions (PHIs) performed by skilled emergency medical service providers during ground or air transport adversely affect outcome in severely injured trauma patients. METHODS: Consecutive trauma activations (March 2012 to June 2013) transported from the scene by air or ground emergency medical service providers were reviewed. PHI was defined as intubation, needle decompression, tourniquet, cricothyroidotomy, or advanced cardiac life support. RESULTS: In 3,733 consecutive trauma activations (71% blunt, 25% penetrating, 4% burns), age was 39 years, 74% were male, Injury Severity Score (ISS) was 5, and Glasgow Coma Score (GCS) was 15, with 32% traumatic brain injury (TBI) and 7% overall mortality. Those who received PHI (n = 130, 3.5% of the trauma activations) were more severely injured: ISS (26 vs. 5), GCS (3 vs. 15), TBI (57% vs. 31%), Revised Trauma Score (RTS, 5.45 vs. 7.84), Trauma and Injury Severity Score (TRISS, 1.32 vs. 4.89), and mortality (56% vs. 5%) were different (all p < 0.05) than those who received no PHI. Air crews transported 22% of the patients; more had TBI, blunt injury, high ISS, and long prehospital times (all p < 0.05), but mortality was similar to those transported by ground. In the most severely injured patients with signs of life who received a PHI, the ISS, prehospital times, and proportions of TBI, blunt trauma, and air transport were similar, but mortality was significantly lower (43% vs. 23%, p= 0.021). CONCLUSION: In our urban trauma system, PHIs are associated with a lower incidence of mortality in severely injured trauma patients and do not delay transport to definitive care. LEVEL OF EVIDENCE: Prognostic/epidemiologic study, level III; therapeutic study, level IV.
Abstract © the authors or publisher, via PubMed. Reuse and removal
Tags
Time intervals · Helicopter & air ambulance · Urban · Mortality & survival
Related articles
- Outcomes of pediatric trauma patients transported from rural and urban scenes. (Air Med J, 2008)
- The utility of helicopter transport of trauma patients from the injury scene in an urban trauma system. (J Trauma, 2002)
- Assessing the evolution of pre-hospital combat casualty care: A comparative study of two conflicts a decade apart. (Am J Emerg Med, 2025)
- Outcomes of blunt trauma victims transported by HEMS from rural and urban scenes. (Prehosp Emerg Care, 2007)
- Shorter times to packed red blood cell transfusion are associated with decreased risk of death in traumatically injured patients. (J Trauma Acute Care Surg, 2016)
- Analysing geospatial variables in the context of trauma networks: A scoping review. (Injury, 2026)