title: Decreased mortality after prehospital interventions in severely injured trauma patients.
abstract: BACKGROUND
  We test the hypothesis that prehospital interventions (PHIs) performed by skilled emergency medical service providers during ground or air transport adversely affect outcome in severely injured trauma patients.
  
  
  METHODS
  Consecutive trauma activations (March 2012 to June 2013) transported from the scene by air or ground emergency medical service providers were reviewed. PHI was defined as intubation, needle decompression, tourniquet, cricothyroidotomy, or advanced cardiac life support.
  
  
  RESULTS
  In 3,733 consecutive trauma activations (71% blunt, 25% penetrating, 4% burns), age was 39 years, 74% were male, Injury Severity Score (ISS) was 5, and Glasgow Coma Score (GCS) was 15, with 32% traumatic brain injury (TBI) and 7% overall mortality. Those who received PHI (n = 130, 3.5% of the trauma activations) were more severely injured: ISS (26 vs. 5), GCS (3 vs. 15), TBI (57% vs. 31%), Revised Trauma Score (RTS, 5.45 vs. 7.84), Trauma and Injury Severity Score (TRISS, 1.32 vs. 4.89), and mortality (56% vs. 5%) were different (all p < 0.05) than those who received no PHI. Air crews transported 22% of the patients; more had TBI, blunt injury, high ISS, and long prehospital times (all p < 0.05), but mortality was similar to those transported by ground. In the most severely injured patients with signs of life who received a PHI, the ISS, prehospital times, and proportions of TBI, blunt trauma, and air transport were similar, but mortality was significantly lower (43% vs. 23%, p= 0.021).
  
  
  CONCLUSIONS
  In our urban trauma system, PHIs are associated with a lower incidence of mortality in severely injured trauma patients and do not delay transport to definitive care.
  
  
  METHODS
  Prognostic/epidemiologic study, level III; therapeutic study, level IV.
authors.affiliation: From the Division of Trauma, Surgical Critical Care, and Burns (J.P.M., E.J.V., C.J.A., J.J.R., J.M.J., L.F.T., N.N., C.I.S., K.G.P.), DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, Florida; and Division of Trauma, Acute Care Surgery, and Surgical Critical Care (D.V.S.), UC Davis Health System, Sacramento, California.
authors.forename: Jonathan P
authors.initials: JP
authors.lastname: Meizoso
authors.forename: Evan J
authors.initials: EJ
authors.lastname: Valle
authors.forename: Casey J
authors.initials: CJ
authors.lastname: Allen
authors.forename: Juliet J
authors.initials: JJ
authors.lastname: Ray
authors.forename: Jassin M
authors.initials: JM
authors.lastname: Jouria
authors.forename: Laura F
authors.initials: LF
authors.lastname: Teisch
authors.forename: David V
authors.initials: DV
authors.lastname: Shatz
authors.forename: Nicholas
authors.initials: N
authors.lastname: Namias
authors.forename: Carl I
authors.initials: CI
authors.lastname: Schulman
authors.forename: Kenneth G
authors.initials: KG
authors.lastname: Proctor
mesh_terms: D000328:Adult; D002983:Clinical Competence; D004632:Emergency Medical Services / Q000379:methods* / Q000706:statistics & numerical data*; D004634:Emergency Medical Technicians; D005260:Female; D005431:Florida / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D012189:Retrospective Studies; D013997:Time Factors; D014187:Transportation of Patients / Q000592:standards; D015599:Trauma Severity Indices; D014505:Urban Population; D014947:Wounds and Injuries / Q000401:mortality* / Q000628:therapy*; D055815:Young Adult