title: Statement of severe trauma management in France; teachings of the FIRST study.
abstract: BACKGROUND
  The blunt trauma victim management is still a matter of debate and comparing studies involving different emergency medical services and health care organization remains fictitious. Hence, the French Intensive care Recorded in Severe Trauma (FIRST) was conducted in order to describe the severe blunt trauma management in France. The present paper aimed at recalling the main results of FIRST study.
  
  
  METHODS
  The FIRST study was based on a multicenter prospective cohort of patients aged 18 or over with severe exclusive blunt trauma requiring admission to university hospital care unit within the first 72h and/or managed by medical-Staffed Emergency Mobile Unit (SMUR). Multiple data were collected about patient characteristics, clinical initial status, typology of trauma and the main endpoints were 30-day mortality.
  
  
  RESULTS
  Sixty-one percent of trauma patients were road traffic victims and 30% were domestic, sport or leisure trauma. Patients who benefited from medical pre-hospital management were globally more severely injured than those who received basic life support care by fire brigades. Therefore, they were delivered more aggressive treatment in the pre-hospital setting and the median time for their hospital admission was lengthened. However, their 30-day mortality was significantly reduced. The probability of death was also decreased when casualties were transported by SMUR helicopter directly to the university hospital. In the in-hospital setting, the performance of a whole-body computed tomography (CT) was associated with a significant reduction in the mortality risk compared with a selective CT.
  
  
  CONCLUSIONS
  The FIRST study suggests the benefit of a medical management in the pre-hospital setting on the survival of trauma patients. The emergency physician (EP) expertise in the pre-hospital and initial hospital phases would lead to the concept of the appropriate care for the appropriate trauma patient. It also highlights the necessity to set up organized regional sectors of care and registries.
authors.affiliation: Department of emergency medicine, university hospital center, 14, rue Paul-Gaffarel, BP 77908, 21079 Dijon, France.
authors.forename: C
authors.initials: C
authors.lastname: Tissier
authors.forename: C
authors.initials: C
authors.lastname: Bonithon-Kopp
authors.forename: M
authors.initials: M
authors.lastname: Freysz
mesh_terms: D000059:Accidents; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000401:Aircraft; D000552:Ambulances; D001794:Blood Pressure / Q000502:physiology; D003422:Critical Care / Q000458:organization & administration / Q000706:statistics & numerical data; D003625:Data Collection; D023381:Endpoint Determination; D005260:Female; D005602:France; D015600:Glasgow Coma Scale; D006801:Humans; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D010346:Patient Care Management / Q000458:organization & administration*; D014057:Tomography, X-Ray Computed; D014218:Triage; D014947:Wounds and Injuries / Q000175:diagnosis / Q000601:surgery / Q000628:therapy*; D014949:Wounds, Nonpenetrating / Q000453:epidemiology / Q000628:therapy; D055815:Young Adult
keywords: Emergency medicine mobile unit; Epidemiological study; Imagerie du traumatisé grave; Medical-staffed air ambulance; Médicalisation héliportée; Pre-hospital management; Prise en charge préhospitalière; Service mobile d’urgence et de réanimation; Severe blunt trauma; Trauma imaging; Traumatisme grave fermé; Étude épidémiologique