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


METHODS
In 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.


RESULTS
37% 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.


CONCLUSIONS
In 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.
University Hospital North Norway, Tromso, Norway.
Mudhafar K
MK
Murad
Stig
S
Larsen
Hans
H
Husum
D000293:Adolescent; D000328:Adult; D002056:Burns / Q000401:mortality; D002648:Child; D007464:Clioquinol; D003150:Community Health Workers; D004632:Emergency Medical Services / Q000458:organization & administration*; D004634:Emergency Medical Technicians; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D007493:Iraq; D054542:Iraq War, 2003-2011; D008020:Life Support Care; D008297:Male; D009104:Multiple Trauma / Q000401:mortality; D014187:Transportation of Patients; D015599:Trauma Severity Indices; D014194:Traumatology / Q000458:organization & administration*; D014947:Wounds and Injuries / Q000401:mortality*; D055815:Young Adult
D007464:Clioquinol