title: Emergency Medical Service (EMS) systems in developed and developing countries.
abstract: OBJECTIVE
  To compare patient- and injury-related characteristics of trauma victims and pre-hospital trauma care systems among different developed and developing countries.
  
  
  METHODS
  We collated de-identified patient-level data from national or local trauma registries in Australia, Austria, Canada, Greece, Germany, Iran, Mexico, New Zealand, the Netherlands, the United Kingdom and the United States. Patient and injury-related characteristics of trauma victims with injury severity score (ISS) >15 and the pre-hospital trauma care provided to these patients were compared among different countries.
  
  
  RESULTS
  A total of 30,339 subjects from one or several regions in 11 countries were included in this analysis. Austria (51%), Germany (41%) and Australia (30%) reported the highest proportion of air ambulance use. Monterrey, Mexico (median 10.1min) and Montreal, Canada (median 16.1min) reported the shortest and Germany (median: 30min) and Austria (median: 26min) reported the longest scene time. Use of intravenous fluid therapy among advanced EMS systems without physicians as pre-hospital care providers, varied from 30% (in the Netherlands) to 55% (in the US). The corresponding percentages in advanced EMS systems with physicians actively involved in pre-hospital trauma care, excluding Montreal in Canada, ranged from 63% (in London, in the UK) to 75% in Germany and Austria. Austria and Germany also reported the highest percentage of pre-hospital intubation (61% and 56%, respectively).
  
  
  CONCLUSIONS
  This study provides an early look at international variability in patient mix, process of care, and performance of different pre-hospital trauma care systems worldwide. International efforts should be devoted to developing a minimum standard data set for trauma patients.
authors.affiliation: Department of Epidemiology, University of Texas, School of Public Health, TX, USA. bahman.roudsari@utsouthwestern.edu
authors.forename: Bahman S
authors.initials: BS
authors.lastname: Roudsari
authors.forename: Avery B
authors.initials: AB
authors.lastname: Nathens
authors.forename: Carlos
authors.initials: C
authors.lastname: Arreola-Risa
authors.forename: Peter
authors.initials: P
authors.lastname: Cameron
authors.forename: Ian
authors.initials: I
authors.lastname: Civil
authors.forename: Giouli
authors.initials: G
authors.lastname: Grigoriou
authors.forename: Russel L
authors.initials: RL
authors.lastname: Gruen
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Koepsell
authors.forename: Fiona E
authors.initials: FE
authors.lastname: Lecky
authors.forename: Rolf L
authors.initials: RL
authors.lastname: Lefering
authors.forename: Moishe
authors.initials: M
authors.lastname: Liberman
authors.forename: Charles N
authors.initials: CN
authors.lastname: Mock
authors.forename: Hans-Jörg
authors.initials: HJ
authors.lastname: Oestern
authors.forename: Elenie
authors.initials: E
authors.lastname: Petridou
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Schildhauer
authors.forename: Christian
authors.initials: C
authors.lastname: Waydhas
authors.forename: Moosa
authors.initials: M
authors.lastname: Zargar
authors.forename: Frederick P
authors.initials: FP
authors.lastname: Rivara
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003431:Cross-Cultural Comparison; D003695:Delivery of Health Care / Q000592:standards*; D019049:Developed Countries; D003906:Developing Countries; D004632:Emergency Medical Services / Q000379:methods / Q000592:standards*; D004636:Emergency Service, Hospital / Q000592:standards*; D005260:Female; D006801:Humans; D008020:Life Support Care / Q000379:methods* / Q000592:standards; D008297:Male; D008875:Middle Aged; D011787:Quality of Health Care / Q000592:standards*; D014187:Transportation of Patients / Q000379:methods; D014193:Trauma Centers / Q000592:standards; D015599:Trauma Severity Indices