title: A review of patients who suddenly deteriorate in the presence of paramedics.
abstract: BACKGROUND
  The report of the Ministerial Review of Trauma and Emergency Services in Victoria, Australia, recommended that paramedics be permitted to divert to the closest hospital in incidences of life threatening situations prior to and during transport. An audit of patients that suddenly deteriorated in paramedic care was recommended by the Ministerial Review. The objective of the study was to identify the number and outcome of patients who suddenly deteriorated in the presence of paramedics.
  
  
  METHODS
  A retrospective cohort study of trauma patients who suddenly deteriorated in the presence of paramedics during 2002. As there was no standard definition, sudden deterioration was defined using a predetermined set of physiological criteria. Patient care record data of patients who suddenly deteriorated were compared with the State Trauma Registry to determine those who sustained hospital defined major trauma. Patient care records where hospital bypass was undertaken were identified and analysed. Ethics committee approval was obtained.
  
  
  RESULTS
  There were 2,893 patients that suddenly deteriorated according to predefined criteria. 2,687 (5.1% of the total trauma patients for 2002) were suitable for further analysis. The majority of patients had a sudden decrease in BP (n = 2,463) with 4.3% having hospital defined major trauma. For patients with a sudden decrease in conscious state or a total GCS score of less than 13 (n = 77), 37.7% had hospital defined major trauma; and a sudden increase/decrease in pulse rate and sudden decrease in BP (n = 65), 26.2% had hospital defined major trauma. Only 28 documented incidents of hospital bypass were identified.
  
  
  CONCLUSIONS
  This study suggests that the incidents of patients suddenly deteriorating in the presence of paramedics are low and the incidence of hospital bypass is not well documented.
authors.affiliation: Monash University, Department of Community Emergency Health and Paramedic Practice, P.O. Box 527, Frankston 3199, Victoria, Australia. mal.boyle@med.monash.edu.au
authors.forename: Malcolm J
authors.initials: MJ
authors.lastname: Boyle
authors.forename: Erin C
authors.initials: EC
authors.lastname: Smith
authors.forename: Frank
authors.initials: F
authors.lastname: Archer
mesh_terms: D000063:Accidents, Traffic / Q000706:statistics & numerical data; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000488:Allied Health Personnel; D002423:Cause of Death; D002648:Child; D015331:Cohort Studies; D018450:Disease Progression; D004630:Emergencies; D004632:Emergency Medical Services / Q000379:methods*; D004634:Emergency Medical Technicians; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000401:mortality / Q000628:therapy; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D017749:Total Quality Management; D014193:Trauma Centers; D014218:Triage; D014739:Victoria; D014947:Wounds and Injuries / Q000175:diagnosis / Q000401:mortality / Q000628:therapy