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

Mudhafar K Murad,Stig Larsen,Hans Husum

doi:10.1186/1757-7241-20-13

Abstract

BackgroundBlunt 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.MethodsIn 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.Results37% 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.ConclusionIn 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.

Highlights

Who is to manage this heavy load of trauma - in disastrous events as well as chronic emergencies like the land mine epidemic? Studies of Western trauma scenarios consistently report that reduced prehospital transport times and level I trauma centers and are the essential components of a good trauma system [2]
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 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)
Since the invasion of Iraq in 2003 the trauma system was expanded to the war zones of Baquba and Kirkuk and Emergency Room paramedics at district hospitals and referral centers were included for training

Summary

Introduction

Studies of Western trauma scenarios consistently report that reduced prehospital transport times and level I trauma centers and are the essential components of a good trauma system [2]. The aims of the study were to evaluate to which extent a low-cost prehospital trauma system reduces deaths where out-of-hospital times are long, and to identify specific prehospital life support interventions that enhance survival. 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

Objectives

Methods

Results

Discussion

Conclusion