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Prehospital management of gunshot patients at major trauma care centers: exploring the gaps in patient care.

Norouzpour A, Khoshdel AR, Modaghegh MH, Kazemzadeh GH - Trauma Mon (2013)

Bottom Line: However, ambulance pre-hospital care was not associated with a shorter hospital stay.EMS (but not private) ambulance transport improved patients' emergency care and standard time intervals were achieved by EMS; however more than a half of the cases were transferred by vehicles other than an ambulance.Nevertheless, ambulance transportation (either by EMS or by private ambulance) was not associated with a shorter hospital stay.

View Article: PubMed Central - PubMed

Affiliation: Department of Epidemiology, Faculty of Medicine, AJA University of Medical Sciences, Tehran, IR Iran ; Vascular and Endovascular Surgery Research Center, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, IR Iran.

ABSTRACT

Background: Prehospital management of gunshot-wounded (GW) patients influences injury-induced morbidity and mortality.

Objectives: To evaluate prehospital management to GW patients emphasizing the protocol of patient transfer to appropriate centers.

Patients and methods: This prospective study, included all GW patients referred to four major, level-I hospitals in Mashhad, Iran. We evaluated demographic data, triage, transport vehicles of patients, hospitalization time and the outcome.

Results: There were 66 GW patients. The most affected body parts were extremities (60.6%, n = 40); 59% of cases (n = 39) were transferred to the hospitals with vehicles other than an ambulance. Furthermore, 77.3% of patients came to the hospitals directly from the site of event, and 22.7% of patients were referred from other medical centers. EMS action intervals from dispatchers to scene departure was not significantly different from established standards; however, arrival to hospital took longer than optimal standards. Additionally, time spent at emergency wards to stabilize vital signs was significantly less in patients who were transported by EMS ambulances (P = 0.01), but not with private ambulances (P = 0.47). However, ambulance pre-hospital care was not associated with a shorter hospital stay. Injury Severity was the only determinant of hospital stay duration (β = 0.36, P = 0.01) in multivariate analysis.

Conclusions: GW was more frequent in extremities and the most patients were directly transferred from the accident site. EMS (but not private) ambulance transport improved patients' emergency care and standard time intervals were achieved by EMS; however more than a half of the cases were transferred by vehicles other than an ambulance. Nevertheless, ambulance transportation (either by EMS or by private ambulance) was not associated with a shorter hospital stay. This showed that upgrade of ambulance equipment and training of private ambulance personnel may be needed.

No MeSH data available.


Related in: MedlinePlus

Duration of Emergency Ward Stay of Patients Based on Type of Transport to the Hospitals1: EMS ambulance; 2: private ambulance; 3: non-ambulance vehicle
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Related In: Results  -  Collection

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fig5475: Duration of Emergency Ward Stay of Patients Based on Type of Transport to the Hospitals1: EMS ambulance; 2: private ambulance; 3: non-ambulance vehicle

Mentions: After arrival to the hospitals, patients received emergency care until their vital signs remained stable. Non-parametric tests demonstrated that EMS-ambulance transported patients had a significantly shorter stay in emergency ward than the group transported by non-ambulance vehicles (median 22 minutes versus 74 minutes, respectively; P = 0.01). There was not such a difference for private ambulance-transported group (P = 0.47) (Figure 4).


Prehospital management of gunshot patients at major trauma care centers: exploring the gaps in patient care.

Norouzpour A, Khoshdel AR, Modaghegh MH, Kazemzadeh GH - Trauma Mon (2013)

Duration of Emergency Ward Stay of Patients Based on Type of Transport to the Hospitals1: EMS ambulance; 2: private ambulance; 3: non-ambulance vehicle
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3860682&req=5

fig5475: Duration of Emergency Ward Stay of Patients Based on Type of Transport to the Hospitals1: EMS ambulance; 2: private ambulance; 3: non-ambulance vehicle
Mentions: After arrival to the hospitals, patients received emergency care until their vital signs remained stable. Non-parametric tests demonstrated that EMS-ambulance transported patients had a significantly shorter stay in emergency ward than the group transported by non-ambulance vehicles (median 22 minutes versus 74 minutes, respectively; P = 0.01). There was not such a difference for private ambulance-transported group (P = 0.47) (Figure 4).

Bottom Line: However, ambulance pre-hospital care was not associated with a shorter hospital stay.EMS (but not private) ambulance transport improved patients' emergency care and standard time intervals were achieved by EMS; however more than a half of the cases were transferred by vehicles other than an ambulance.Nevertheless, ambulance transportation (either by EMS or by private ambulance) was not associated with a shorter hospital stay.

View Article: PubMed Central - PubMed

Affiliation: Department of Epidemiology, Faculty of Medicine, AJA University of Medical Sciences, Tehran, IR Iran ; Vascular and Endovascular Surgery Research Center, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, IR Iran.

ABSTRACT

Background: Prehospital management of gunshot-wounded (GW) patients influences injury-induced morbidity and mortality.

Objectives: To evaluate prehospital management to GW patients emphasizing the protocol of patient transfer to appropriate centers.

Patients and methods: This prospective study, included all GW patients referred to four major, level-I hospitals in Mashhad, Iran. We evaluated demographic data, triage, transport vehicles of patients, hospitalization time and the outcome.

Results: There were 66 GW patients. The most affected body parts were extremities (60.6%, n = 40); 59% of cases (n = 39) were transferred to the hospitals with vehicles other than an ambulance. Furthermore, 77.3% of patients came to the hospitals directly from the site of event, and 22.7% of patients were referred from other medical centers. EMS action intervals from dispatchers to scene departure was not significantly different from established standards; however, arrival to hospital took longer than optimal standards. Additionally, time spent at emergency wards to stabilize vital signs was significantly less in patients who were transported by EMS ambulances (P = 0.01), but not with private ambulances (P = 0.47). However, ambulance pre-hospital care was not associated with a shorter hospital stay. Injury Severity was the only determinant of hospital stay duration (β = 0.36, P = 0.01) in multivariate analysis.

Conclusions: GW was more frequent in extremities and the most patients were directly transferred from the accident site. EMS (but not private) ambulance transport improved patients' emergency care and standard time intervals were achieved by EMS; however more than a half of the cases were transferred by vehicles other than an ambulance. Nevertheless, ambulance transportation (either by EMS or by private ambulance) was not associated with a shorter hospital stay. This showed that upgrade of ambulance equipment and training of private ambulance personnel may be needed.

No MeSH data available.


Related in: MedlinePlus