title: Preventable death evaluation of the appropriateness of the on-site trauma care provided by Urgences-Santé physicians.
abstract: The study is based on 44 preventable deaths occurring in a cohort of 360 patients with major trauma. These cases were reviewed by a committee of nine experts. The mean Injury Severity Score (ISS) was 28, and most cases had injuries to the head/neck (68%) and chest (64%). The mean (+/- SD) observed prehospital times, and those considered the maximum allowable by the committee, were 40.6 +/- 12.0 minutes for head/neck injuries and 23.9 +/- 12.2 minutes for chest injuries (p < 0.05). Intravenous (i.v.) lines were started in 38 (86%) of the patients. The committee classified this procedure as harmful for 16 (42%) and neutral for 19 (50%). Among the 18 (46%) that were intubated, this intervention was considered harmful for 17% and neutral for 39%. In two of the three patients for whom a pneumatic antishock garment was applied, this procedure was considered harmful. Of the 34 patients that required direct transport at a level I trauma center, 50% were transferred to such a hospital. These results show significant prehospital delays and high rates of inappropriate IV line initiation and intubation in trauma patients receiving on-site care by physicians. We conclude that prehospital care protocols for trauma patients should emphasize prompt transport and specific on-site care algorithms.
mesh_terms: D000328:Adult; D004632:Emergency Medical Services; D004634:Emergency Medical Technicians; D004636:Emergency Service, Hospital; D005260:Female; D005676:Gravity Suits / Q000009:adverse effects; D006801:Humans; D007262:Infusions, Intravenous / Q000009:adverse effects; D015601:Injury Severity Score; D007442:Intubation, Intratracheal / Q000009:adverse effects; D008020:Life Support Care; D008297:Male; D008875:Middle Aged; D010360:Patient Transfer; D010820:Physicians; D015996:Survival Rate; D013997:Time Factors; D014193:Trauma Centers; D014947:Wounds and Injuries / Q000401:mortality* / Q000628:therapy*