title: Pre-hospital severe traumatic brain injury - comparison of outcome in paramedic versus physician staffed emergency medical services.
abstract: BACKGROUND
  Traumatic brain injury (TBI) is one of the leading causes of death and permanent disability. Emergency Medical Services (EMS) personnel are often the first healthcare providers attending patients with TBI. The level of available care varies, which may have an impact on the patient's outcome. The aim of this study was to evaluate mortality and neurological outcome of TBI patients in two regions with differently structured EMS systems.
  
  
  METHODS
  A 6-year period (2005 - 2010) observational data on pre-hospital TBI management in paramedic-staffed EMS and physician-staffed EMS systems were retrospectively analysed. Inclusion criteria for the study were severe isolated TBI presenting with unconsciousness defined as Glasgow coma scale (GCS) score ≤ 8 occurring either on-scene, during transportation or verified by an on-call neurosurgeon at admission to the hospital. For assessment of one-year neurological outcome, a modified Glasgow Outcome Score (GOS) was used.
  
  
  RESULTS
  During the 6-year study period a total of 458 patients met the inclusion criteria. One-year mortality was higher in the paramedic-staffed EMS group: 57 % vs. 42 %. Also good neurological outcome was less common in patients treated in the paramedic-staffed EMS group.
  
  
  CONCLUSIONS
  We found no significant difference between the study groups when considering the secondary brain injury associated vital signs on-scene. Also on arrival to ED, the proportion of hypotensive patients was similar in both groups. However, hypoxia was common in the patients treated by the paramedic-staffed EMS on arrival to the ED, while in the physician-staffed EMS almost none of the patients were hypoxic. Pre-hospital intubation by EMS physicians probably explains this finding.
  
  
  CONCLUSIONS
  The results suggest to an outcome benefit from physician-staffed EMS treating TBI patients.
  
  
  BACKGROUND
  ClinicalTrials.gov ID NCT01454648.
authors.affiliation: FinnHEMS Ltd, Research and Development Unit, Vantaa, Finland. toni.pakkanen@fimnet.fi.|Department of Anaesthesia, Tampere University Hospital, Tampere, Finland. toni.pakkanen@fimnet.fi.
authors.forename: Toni
authors.initials: T
authors.lastname: Pakkanen
authors.affiliation: FinnHEMS Ltd, Research and Development Unit, Vantaa, Finland.
authors.forename: Ilkka
authors.initials: I
authors.lastname: Virkkunen
authors.affiliation: Tays Emergency Medical Service, FinnHEMS 30, Tampere University Hospital, Tampere, Finland.
authors.forename: Antti
authors.initials: A
authors.lastname: Kämäräinen
authors.affiliation: School of Health Sciences, University of Tampere, Tampere, Finland.
authors.forename: Heini
authors.initials: H
authors.lastname: Huhtala
authors.affiliation: Department of Anaesthesia and Intensive Care, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.
authors.forename: Tom
authors.initials: T
authors.lastname: Silfvast
authors.affiliation: Tays Emergency Medical Service, FinnHEMS 30, Tampere University Hospital, Tampere, Finland.
authors.forename: Janne
authors.initials: J
authors.lastname: Virta
authors.affiliation: Department of Anaesthesia and Intensive Care, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.
authors.forename: Tarja
authors.initials: T
authors.lastname: Randell
authors.affiliation: Department of Anaesthesia, Tampere University Hospital, Tampere, Finland.|Medical School, University of Tampere, Tampere, Finland.
authors.forename: Arvi
authors.initials: A
authors.lastname: Yli-Hankala
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000488:Allied Health Personnel; D000070642:Brain Injuries, Traumatic / Q000175:diagnosis / Q000628:therapy*; D004632:Emergency Medical Services; D005260:Female; D005500:Follow-Up Studies; D015600:Glasgow Coma Scale; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010820:Physicians; D012189:Retrospective Studies; D013997:Time Factors; D000078329:Workforce; D055815:Young Adult
keywords: Airway Management (MeSH); Critical Care (MeSH); Emergency Medical Services (MeSH); Endotracheal Intubation (MeSH); Glasgow Outcome Scale (MeSH); Patient Outcome Assessment (MeSH); Pre-hospital Emergency Care (MeSH); Traumatic Brain Injury (MeSH)