title: Paramedic vs private transportation of trauma patients. Effect on outcome.
abstract: BACKGROUND
  Prehospital emergency medical services (EMS) play a major role in any trauma system. However, there is very little information regarding the role of prehospital emergency care in trauma. To investigate this issue, we compared the outcome of severely injured patients transported by paramedics (EMS group) with the outcome of those transported by friends, relatives, bystanders, or police (non-EMS group).
  
  
  METHODS
  We compared 4856 EMS patients with 926 non-EMS patients. General linear model analysis was performed to test the hypothesis that hospital mortality is the same in EMS and non-EMS cases, controlling for the following confounding factors, which are not affected by mode of transportation: age, gender, mechanism of injury, cause of injury, Injury Severity Score (ISS), and severe head injury. Crude, specific, and adjusted mortality rates and relative risks were also derived for the EMS and non-EMS groups.
  
  
  METHODS
  Large, urban, academic level I trauma center.
  
  
  METHODS
  All patients meeting the criteria for major trauma.
  
  
  RESULTS
  The two groups were similar with regard to mechanism of injury and the need for surgery or intensive care unit admission. The crude mortality rate was 9.3% in the EMS group and 4.0% in the non-EMS group (relative risk, 2.32; P < .001). After adjustment for ISS, the relative risk was 1.60 (P = .002). Subgroup analysis showed that among patients with ISS greater than 15, those in the EMS group had a mortality rate twice that of those in the non-EMS group (28.8% vs 14.1%). After controlling for confounding factors, the adjusted mortality among patients with ISS greater than 15 was 28.2% for the EMS group and 17.9% for the non-EMS group (P < .001).
  
  
  CONCLUSIONS
  Patients with severe trauma transported by private means in this setting have better survival than those transported via the EMS system. Large prospective studies are needed to identify the factors responsible for this difference.
authors.affiliation: Department of Surgery, Los Angeles Medical Center, Los Angeles, USA.
authors.forename: D
authors.initials: D
authors.lastname: Demetriades
authors.forename: L
authors.initials: L
authors.lastname: Chan
authors.forename: E
authors.initials: E
authors.lastname: Cornwell
authors.forename: H
authors.initials: H
authors.lastname: Belzberg
authors.forename: T V
authors.initials: TV
authors.lastname: Berne
authors.forename: J
authors.initials: J
authors.lastname: Asensio
authors.forename: D
authors.initials: D
authors.lastname: Chan
authors.forename: M
authors.initials: M
authors.lastname: Eckstein
authors.forename: K
authors.initials: K
authors.lastname: Alo
mesh_terms: D000328:Adult; D000367:Age Factors; D000552:Ambulances; D015986:Confounding Factors, Epidemiologic; D006259:Craniocerebral Trauma / Q000209:etiology / Q000401:mortality / Q000503:physiopathology; D004632:Emergency Medical Services; D005190:Family; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015601:Injury Severity Score; D016014:Linear Models; D015141:Los Angeles / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D016495:Police; D012307:Risk Factors; D012737:Sex Factors; D015996:Survival Rate; D014187:Transportation of Patients; D014947:Wounds and Injuries / Q000209:etiology / Q000401:mortality / Q000503:physiopathology