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Prehospital trauma care reduces mortality. Ten-year results from a time-cohort and trauma audit study in Iraq.

Murad MK, Larsen S, Husum H - Scand J Trauma Resusc Emerg Med (2012)

Bottom Line: The study was conducted with a time-period cohort design. 37% of the study patients had serious injuries with Injury Severity Score ≥ 9.The mean prehospital transport time was 2.5 hours (95% CI 1.9 - 3.2).Delegating life-saving skills to paramedics and lay people is a key factor for efficient prehospital trauma systems in low-resource communities.

View Article: PubMed Central - HTML - PubMed

Affiliation: University Hospital North Norway, Tromso, Norway.

ABSTRACT

Background: Blunt implementation of Western trauma system models is not feasible in low-resource communities with long prehospital transit times. The aims of the study were to evaluate to which extent a low-cost prehospital trauma system reduces trauma deaths where prehospital transit times are long, and to identify specific life support interventions that contributed to survival.

Methods: In the study period from 1997 to 2006, 2,788 patients injured by land mines, war, and traffic accidents were managed by a chain-of-survival trauma system where non-graduate paramedics were the key care providers. The study was conducted with a time-period cohort design.

Results: 37% of the study patients had serious injuries with Injury Severity Score ≥ 9. The mean prehospital transport time was 2.5 hours (95% CI 1.9 - 3.2). During the ten-year study period trauma mortality was reduced from 17% (95% CI 15 -19) to 4% (95% CI 3.5 - 5), survival especially improving in major trauma victims. In most patients with airway problems, in chest injured, and in patients with external hemorrhage, simple life support measures were sufficient to improve physiological severity indicators.

Conclusion: In case of long prehospital transit times simple life support measures by paramedics and lay first responders reduce trauma mortality in major injuries. Delegating life-saving skills to paramedics and lay people is a key factor for efficient prehospital trauma systems in low-resource communities.

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Trauma system expansion by time periods. In period 1 (1997 - 2000, red), the trauma system targeted landmine accidents; in period 2, (2001 - 2003, green), the system was expanded to also include highway road-traffic accidents; in period 3 (2004 - 2006, blue) the system additionally focused on war victims. The referral hospitals (Kirkuk and Suleimaniah Teaching Hospitals) are marked in boxes.
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Figure 1: Trauma system expansion by time periods. In period 1 (1997 - 2000, red), the trauma system targeted landmine accidents; in period 2, (2001 - 2003, green), the system was expanded to also include highway road-traffic accidents; in period 3 (2004 - 2006, blue) the system additionally focused on war victims. The referral hospitals (Kirkuk and Suleimaniah Teaching Hospitals) are marked in boxes.

Mentions: The reference population consists of trauma patients in low-income countries with long pre-hospital transport times. The study was conducted with a time-period cohort design defined by a stepwise expansion of the actual trauma system: In period 1, from 1997 to 2000, the catchments area of the prehospital trauma system was the rural mine fields of Northern Iraq; in period 2, from 2001 to 2003, the trauma system was expanded to also target highway traffic accidents in the Northern sector while still being operational in the rural North; from 2004 to 2006 the trauma system developed further to include the war zones of Central Iraq, yet still in action in the previous catchments areas (Figure 1).


Prehospital trauma care reduces mortality. Ten-year results from a time-cohort and trauma audit study in Iraq.

Murad MK, Larsen S, Husum H - Scand J Trauma Resusc Emerg Med (2012)

Trauma system expansion by time periods. In period 1 (1997 - 2000, red), the trauma system targeted landmine accidents; in period 2, (2001 - 2003, green), the system was expanded to also include highway road-traffic accidents; in period 3 (2004 - 2006, blue) the system additionally focused on war victims. The referral hospitals (Kirkuk and Suleimaniah Teaching Hospitals) are marked in boxes.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3298775&req=5

Figure 1: Trauma system expansion by time periods. In period 1 (1997 - 2000, red), the trauma system targeted landmine accidents; in period 2, (2001 - 2003, green), the system was expanded to also include highway road-traffic accidents; in period 3 (2004 - 2006, blue) the system additionally focused on war victims. The referral hospitals (Kirkuk and Suleimaniah Teaching Hospitals) are marked in boxes.
Mentions: The reference population consists of trauma patients in low-income countries with long pre-hospital transport times. The study was conducted with a time-period cohort design defined by a stepwise expansion of the actual trauma system: In period 1, from 1997 to 2000, the catchments area of the prehospital trauma system was the rural mine fields of Northern Iraq; in period 2, from 2001 to 2003, the trauma system was expanded to also target highway traffic accidents in the Northern sector while still being operational in the rural North; from 2004 to 2006 the trauma system developed further to include the war zones of Central Iraq, yet still in action in the previous catchments areas (Figure 1).

Bottom Line: The study was conducted with a time-period cohort design. 37% of the study patients had serious injuries with Injury Severity Score ≥ 9.The mean prehospital transport time was 2.5 hours (95% CI 1.9 - 3.2).Delegating life-saving skills to paramedics and lay people is a key factor for efficient prehospital trauma systems in low-resource communities.

View Article: PubMed Central - HTML - PubMed

Affiliation: University Hospital North Norway, Tromso, Norway.

ABSTRACT

Background: Blunt implementation of Western trauma system models is not feasible in low-resource communities with long prehospital transit times. The aims of the study were to evaluate to which extent a low-cost prehospital trauma system reduces trauma deaths where prehospital transit times are long, and to identify specific life support interventions that contributed to survival.

Methods: In the study period from 1997 to 2006, 2,788 patients injured by land mines, war, and traffic accidents were managed by a chain-of-survival trauma system where non-graduate paramedics were the key care providers. The study was conducted with a time-period cohort design.

Results: 37% of the study patients had serious injuries with Injury Severity Score ≥ 9. The mean prehospital transport time was 2.5 hours (95% CI 1.9 - 3.2). During the ten-year study period trauma mortality was reduced from 17% (95% CI 15 -19) to 4% (95% CI 3.5 - 5), survival especially improving in major trauma victims. In most patients with airway problems, in chest injured, and in patients with external hemorrhage, simple life support measures were sufficient to improve physiological severity indicators.

Conclusion: In case of long prehospital transit times simple life support measures by paramedics and lay first responders reduce trauma mortality in major injuries. Delegating life-saving skills to paramedics and lay people is a key factor for efficient prehospital trauma systems in low-resource communities.

Show MeSH
Related in: MedlinePlus