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

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

Hans Husum¹  Stig Larsen³  Mudhafar K Murad² 

[1] Tromso Mine Victim Resource Center, University Hospital North Norway, Tromso, Norway;Institute of Clinical Medicine, Faculty of Health Sciences, University of Tromso, Norway;Center for Epidemiology and Biostatistics, Norwegian School of Veterinary Science, Oslo, Norway

关键词: War;    Trauma mortality;    Trauma audit;    Severity indices;    Prehospital;    Life support;    Land mine;    Iraq;   

Others  :  826780
DOI  :  10.1186/1757-7241-20-13

 received in 2011-11-14, accepted in 2012-02-03,  发布年份 2012

【 摘 要 】

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.

【 授权许可】

   
2012 Murad et al; licensee BioMed Central Ltd.

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【 参考文献 】

• [1]Mathers CD, Joncar D: Updated projections of global mortality and burden of disease, 2002 - 2030: data sources, methods, and results. [http://www.who.int/healthinfo/statistics/bod_projections2030_-paper.pdf] webcite accessed 30/10/2011
• [2]Demetriades D, Martin M, Salim A, Rhee P, Brown C, Chan L: The effect of trauma center designation and trauma volume on outcome in specific injuries. Ann Surg 2005, 242:512-17.
• [3]Burnham G, Lafta R, Doocy S, Roberts L: Mortality after the 2003 invasion of Iraq: a cross-sectional cluster sample survey. Lancet 2006, 368:1421-8. Erratum in: Lancet 2009; 373: 810
• [4]Jahanlu HR, Husum H, Wisborg T: Mortality in landmine accidents in Iran. Prehosp Disast Med 2002, 17:107-9.
• [5]Husum H, Gilbert M, Wisborg T: Save Lives, Save Limbs. Life support to victims of mines, wars, and accidents. Penang, Malaysia: Third World Network; 2000.
• [6]Association for the Advancement of Automotive Medicine: The Abbreviated Injury Scale, 1990 revision, update 98. Des Plaines, IL; 1998:IX.
• [7]Husum H, Gilbert M, Wisborg T, Heng YV, Murad M: Respiratory rate as prehospital triage tool in rural trauma. J Trauma 2003, 55:466-70.
• [8]Champion HR, Copes WS, Sacco WJ, Lawnick MM, Keast SL, Bain LW Jr, Flanagan ME, Frey CF: The Major Trauma Outcome Study: Establishing national norms for trauma care. J Trauma 1990, 30:1356-65.
• [9]Karmy-Jones R, Copes WS, Champion HR, Weigelt J, Shackford S, Lawnick M, Rozycki GS, Hollingsworth-Fridlund P, Klein J: Results of a multi-institutional outcome assessment: results of a structured peer review of TRISS-designated unexpected outcomes. J Trauma 1992, 32:196-203.
• [10]Altman DC: Practical statistics for medical research. London: Chapman & Hall/CRC; 1999.
• [11]Agresti A: Categorical Data Analysis. New Jersey: John Wiley & Sons; 2002.
• [12]Zweig MH, Campbell G: Receiver-Operating Characteristic (ROC) Plots: A fundamental evaluation tool in clinical medicine. Clin Chem 1993, 39:561-77.
• [13]Murad KM, Husum H: Trained lay first responders reduce trauma mortality: a controlled study of rural trauma in Iraq. Prehosp Disast Med 2010, 25:533-39.
• [14]National Bioethics Advisory Commission: Ethical and Policy Issues in International Research: Clinical Trials in Developing Countries. NBAC: Maryland; 2001:iii-vi.
• [15]Ruddy RM, Fleisher GR: An approach to the injured child. In Textbook of Pediatric Emergency Medicine. Edited by Fleisher GR, Ludwig S, Henretig FM. Philadelphia: Lippincott, Williams and Wilkins; 2006:1339.
• [16]Engum SA, Mitchell MK, Scherer G, Gomez G, Jacobson L, Solotkin K, Grosfeld JL: Prehospital triage in the injured pediatric patient. J Pediatr Surg 2000, 35:82-7.
• [17]Wolf SJ, Bebarta VS, Bonnett CJ, Pons PT, Cantrill SV: Blast Injuries. Lancet 2009, 374:405-15.
• [18]Ryynänen OP, Iirola T, Reitala J, Pälve H, Malmivaara A: Is advanced life support better than basic life support in prehospital care? A systematic review. Scand J Trauma Resusc Emerg Med 2010, 23:18-62.
• [19]Holcomb JB, McMullin NR, Pearse L, et al.: Causes of death in U.S. Special Operations Forces in the global war on terrorism: 2001 - 2004. Ann Surg 2007, 245:986-91.
• [20]Husum H, Olsen T, Murad M, et al.: Preventing post-injury hypothermia during prolonged prehospital evacuation. Prehosp Disast Med 2002, 17:13-6.