Abstract 322: Prehospital Care From Emergency Life-Saving Technicians Promotes the Survival of Trauma Patients

Abstract

Introduction: Optimal trauma care strategies remain a matter of debate. Prehospital trauma care protocols for paramedics range from no intervention to full field stabilizations. In Japan, emergency life-saving technicians (ELSTs) are certified specialists trained to provide advanced techniques and knowledge for prehospital emergency care. They can give fluid resuscitation and inform the receiving hospital for definitive surgery. However, the effectiveness of ELSTs over basic emergency medical technicians (BEMTs) regarding trauma transport remains unclear. Hypothesis: We tested whether the presence of an ELST improves the outcomes of trauma patients. Methods: We retrospectively studied 2004- 2017 data from the Japan Trauma Data Bank (JTDB). Inclusion criteria were patients age ≥ 16 with at least one Abbreviated Injury Scale (AIS) score ≥ 3 trauma. Exclusion criteria were patients with burns, AIS score = 6 in any region, and missing data. We compared two trauma patient groups. ELST group: patients transported by EMS including at least one ELST. BEMT group: patients transported only by basic EMS personnel. The primary outcome measure was survival at discharge. A multivariable logistic regression model was used to adjust for patient baseline characteristics. Results: Included were 124,563 patients, with 119,352 patients in the ELST group and 5,211 patients in the BEMT group. Patients’ ages (ELST vs. BEMT [Mean ± SD]: 57 ± 22 vs. 59 ± 22 years, p < 0.01) were lower and transportation time (15 ± 12 vs. 17 ± 14 min, p < 0.01) was shorter in the ELST group. Gender (male: 64 vs. 64 %, p = 0.66), proportion of blunt trauma (96 vs. 96 %, p = 0.10), proportion of blood transfusion (15 vs. 14 %, p = 0.11) and Injury Severity Score (16 ± 11 vs. 16 ± 11, p = 0.28) were similar between groups. Revised Trauma Score (7.0 ± 1.9 vs. 7.1± 1.7, p < 0.01) was lower in the ELST group and proportion of emergency surgery (12 vs. 11 %, p < 0.01) was higher in the ELST group, indicating that ELSTs treat more severe cases. In the multivariable logistic regression, the ELST group had higher odds for survival (adjusted OR: 1.18, 95% CI: 1.01-1.37). Conclusions: ELSTs encountered more severe cases than BEMTs. After adjustment, transport by the ELST group was associated with improved survival of trauma patients.