title: An analysis of prehospital deaths: Who can we save?
abstract: BACKGROUND
  Since their inception in the late 1970s, trauma networks have saved thousands of lives in the prehospital setting. However, few recent works have been done to evaluate the patients who die in the field. Understanding the epidemiology of these deaths is crucial for trauma system performance evaluation and improvement. We hypothesized that specific patterns of injury could be identified and targeted for intervention.
  
  
  METHODS
  Medical examiner reports in a large, urban county were reviewed including all trauma deaths during 2011 that were not transported to a hospital (i.e., died at the scene) or dead on arrival. Age, sex, date of death, mechanism, and list of injuries were recorded. An expert panel reviewed each case to determine the primary cause of death, and if the patient's death was caused by potentially survivable injuries or nonsurvivable injuries.
  
  
  RESULTS
  A total of 512 patients were included. Patients were 80% male, died mostly of blunt (53%) and penetrating (46%) causes, and included 21% documented suicides. The leading cause of death was neurotrauma (36%), followed by hemorrhage (34%), asphyxia (15%), and combined neurotrauma/hemorrhage (15%). The anatomic regions most frequently injured were the brain (59%), chest (54%), and abdomen (35%). Finally, 29% of the patient deaths were classified as a result of potentially survivable injuries given current treatment options, mostly from hemorrhage and chest injuries.
  
  
  CONCLUSIONS
  More than one of every five trauma deaths in our study population had potentially survivable injuries. In this group, chest injuries and death via hemorrhage were predominant and suggest targets for future research and implementation of novel prehospital interventions. In addition, efforts targeting suicide prevention remain of great importance.
  
  
  METHODS
  Epidemiologic study, level V.
authors: From the DeWitt Daughtry Department of Surgery (J.S.D., S.S.S., H.D., D.N., K.J., R.M.V.H., N.N., C.I.S.), Jackson Memorial Hospital/University of Miami, Miller School of Medicine, Miami, Florida; Committee on Tactical Combat Casualty Care and Prehospital Trauma Care (F.K.B.), Joint Trauma System San Antonio, Texas; and Department of Surgery (L.H.B.), Brooke Army Medical Center, Fort Sam Houston, San Antonio, Texas; and Department of Military and Emergency Medicine (F.K.B.), Uniformed Services University of the Health Sciences, Bethesda, Maryland.
authors: James S
authors: JS
authors: Davis
authors: Shevonne S
authors: SS
authors: Satahoo
authors: Frank K
authors: FK
authors: Butler
authors: Harrison
authors: H
authors: Dermer
authors: Daniel
authors: D
authors: Naranjo
authors: Katherina
authors: K
authors: Julien
authors: Robert M
authors: RM
authors: Van Haren
authors: Nicholas
authors: N
authors: Namias
authors: Lorne H
authors: LH
authors: Blackbourne
authors: Carl I
authors: CI
authors: Schulman
mesh_terms: D000328:Adult; D000367:Age Factors; D002423:Cause of Death; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D005431:Florida / Q000453:epidemiology; D006801:Humans; D008297:Male; D009026:Mortality; D012189:Retrospective Studies; D012737:Sex Factors; D014505:Urban Population / Q000706:statistics & numerical data; D014947:Wounds and Injuries / Q000401:mortality