title: Pre-hospital rescue times and actions in severe trauma. A comparison between two trauma systems: Germany and the Netherlands.
abstract: BACKGROUND
  The aim of this study was to compare the effect of national pre-hospital rescue strategies on the status of severely injured patients at the time of admission to a Trauma Center (TC) in Germany or the Netherlands.
  
  
  METHODS
  This retrospective database analysis based on the TraumaRegister DGU(®) (TR-DGU) of the German Trauma Society compares the pre-hospital trauma system of Germany with three Trauma Centers (TCs) from the Netherlands. It comprises trauma patients from 2009 to 2012 admitted to a Level I TC, all patients aged 16-80 years primarily admitted with an ISS ≥ 16 and data available for mode of transport, pre-hospital measures and total pre-hospital time. Additionally three subgroups were formed by mode of transportation and involved personnel: Ambulance/Physician, Helicopter/Physician, Ambulance/EMT. Primary endpoint is the patient's status at the time of admission to the trauma room. Secondary endpoint is hospital mortality.
  
  
  RESULTS
  A total of 12,168 patients met the inclusion criteria. Major differences in the injury patterns, pre-hospital rescue time, transport strategy and actions are documented. The mean ISS in the German overall group was 28.6 ± 12.2 compared to 27.4 ± 12.8 in the Dutch overall group. In the subgroups the highest injury severity with 29.8 ± 12.7 for German patients and 31.0 ± 14.6 for Dutch patients was found in the Helicopter/Physician subgroups and the lowest in patients transported by ambulance under emergency medical technician (EMT) care i.e. 24.2 ± 8.9 for German patients and 23.6 ± 10.3 for Dutch patients. The mean total pre-hospital time for patients admitted to Dutch TCs of 53.8 ± 28.7 min was 15.1 min shorter than for patients transported to German TCs 68.7 ± 28.6 min. The overall mean pre-hospital volume replacement of 1103 ± 821 ml for German patients was about twice as high as for Dutch patients (541 ± 700 ml). In physician led subgroups in the Netherlands higher rates of intubation, catecholamine administration and chest tubes are recorded. The basic vital signs from on-scene to hospital admission did not show relevant changes. Additional parameters available in the trauma room revealed a lower mean Base Excess (BE) for Dutch patients and a diminished mean prothrombin ratio for German patients. No reliable evidence was found that differences in the mortality analysis resulted from different national pre-hospital strategy.
  
  
  CONCLUSIONS
  Many differences in the national pre-hospital strategy were demonstrated but the effect on patient's status at the time of admission to trauma room remains unclear. A follow-up study, which mitigates the now known injury patterns has to be initiated to further substantiate the findings of this study.
authors.affiliation: Department of Trauma and Orthopedic Surgery, University of Witten/Herdecke, Cologne-Merheim Medical Centre (CMMC), Ostmerheimer Str. 200, 51109 Cologne, Germany. Electronic address: atimm.unikoeln@yahoo.de.
authors.forename: Alexander
authors.initials: A
authors.lastname: Timm
authors.affiliation: Department of Trauma and Orthopedic Surgery, University of Witten/Herdecke, Cologne-Merheim Medical Centre (CMMC), Ostmerheimer Str. 200, 51109 Cologne, Germany.
authors.forename: Marc
authors.initials: M
authors.lastname: Maegele
authors.affiliation: Institute for Research in Operative Medicine (IFOM), University of Witten/Herdecke, Ostermerheimer Str. 200, Building 38, 51109 Cologne, Germany.
authors.forename: Rolf
authors.initials: R
authors.lastname: Lefering
authors.affiliation: Department of Trauma Surgery, University of Groningen, University Medical Center Groningen (UMCG), Hanzeplein 1, 9700 RB Groningen, The Netherlands.
authors.forename: Klaus
authors.initials: K
authors.lastname: Wendt
authors.affiliation: Department of Trauma, Hand and Reconstructive Surgery, Hospital of the Johann Wolfgang Goethe-University, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany.
authors.forename: Hendrik
authors.initials: H
authors.lastname: Wyen
mesh_terms: D000293:Adolescent; D000328:Adult; D000552:Ambulances / Q000458:organization & administration / Q000706:statistics & numerical data; D004632:Emergency Medical Services / Q000458:organization & administration / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D017052:Hospital Mortality; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D011785:Quality Assurance, Health Care / Q000639:trends*; D012042:Registries; D012189:Retrospective Studies; D013997:Time Factors; D014193:Trauma Centers / Q000458:organization & administration / Q000639:trends; D014947:Wounds and Injuries / Q000401:mortality / Q000628:therapy*
keywords: Emergency medical services; Germany; International comparison; Major trauma; Pre-hospital care; Rescue times; The Netherlands