title: Does the presence of an emergency physician influence pre-hospital time, pre-hospital interventions and the mortality of severely injured patients? A matched-pair analysis based on the trauma registry of the German Trauma Society (TraumaRegister DGU®).
abstract: OBJECTIVE
  The role of emergency physicians in the pre-hospital management of severely injured patients remains controversial. In Germany and Austria, an emergency physician is present at the scene of an emergency situation or is called to such a scene in order to provide pre-hospital care to severely injured patients in approximately 95% of all cases. By contrast, in the United States and the United Kingdom, paramedics, i.e. non-physician teams, usually provide care to an injured person both at the scene of an incident and en route to an appropriate hospital. We investigated whether physician or non-physician care offers more benefits and what type of on-site care improves outcome.
  
  
  METHODS
  In a matched-pair analysis using data from the trauma registry of the German Trauma Society, we retrospectively (2002-2011) analysed the pre-hospital management of severely injured patients (ISS ≥16) by physician and non-physician teams. Matching criteria were age, overall injury severity, the presence of relevant injuries to the head, chest, abdomen or extremities, the cause of trauma, the level of consciousness, and the presence of shock.
  
  
  RESULTS
  Each of the two groups, i.e. patients who were attended by an emergency physician and those who received non-physician care, consisted of 1235 subjects. There was no significant difference between the two groups in pre-hospital time (61.1 [SD 28.9] minutes for the physician group and 61.9 [SD 30.9] minutes for non-physician group). Significant differences were found in the number of pre-hospital procedures such as fluid administration, analgosedation and intubation. There was a highly significant difference (p<0.001) in the number of patients who received no intervention at all applying to 348 patients (28.2%) treated by non-physician teams and to only 31 patients (2.5%) in the physician-treated group. By contrast, there was no significant difference in mortality within the first 24h and in mortality during hospitalisation.
  
  
  CONCLUSIONS
  This retrospective analysis does not allow definitive conclusions to be drawn about the optimal model of pre-hospital care. It shows, however, that there was no significant difference in mortality although patients who were attended by non-physician teams received fewer pre-hospital interventions with similar scene times.
authors: Department of Trauma Surgery and Orthopaedics, Reconstructive Surgery, Hand Surgery and Burn Medicine, German Armed Forces Central Hospital of Koblenz, Ruebenacher Strasse 170, 56072 Koblenz, Germany. Electronic address: dr.dan.bieler@t-online.de.
authors: Dan
authors: D
authors: Bieler
authors: Department of Trauma Surgery and Orthopaedics, Reconstructive Surgery, Hand Surgery and Burn Medicine, German Armed Forces Central Hospital of Koblenz, Ruebenacher Strasse 170, 56072 Koblenz, Germany. Electronic address: dr.axel.franke@t-online.de.
authors: Axel
authors: A
authors: Franke
authors: Institute for Research in Operative Medicine (IFOM), Witten/Herdecke University, Ostmerheimer Strasse 200, 51109 Cologne, Germany.
authors: Rolf
authors: R
authors: Lefering
authors: Department of Trauma Surgery and Orthopaedics, Reconstructive Surgery, Hand Surgery and Burn Medicine, German Armed Forces Central Hospital of Koblenz, Ruebenacher Strasse 170, 56072 Koblenz, Germany.
authors: Sebastian
authors: S
authors: Hentsch
authors: Department of General, Visceral and Thoracic Surgery, German Armed Forces Central Hospital of Koblenz, Ruebenacher Strasse 170, 56072 Koblenz, Germany.
authors: Arnulf
authors: A
authors: Willms
authors: Department of Anaesthesiology and Intensive Care, German Armed Forces Hospital of Ulm, Oberer Eselsberg 40, 89081 Ulm, Germany.
authors: Martin
authors: M
authors: Kulla
authors: Department of Trauma Surgery and Orthopaedics, Reconstructive Surgery, Hand Surgery and Burn Medicine, German Armed Forces Central Hospital of Koblenz, Ruebenacher Strasse 170, 56072 Koblenz, Germany.
authors: Erwin
authors: E
authors: Kollig
authors: Committee on Emergency Medicine, Intensive Care and Trauma Management (Sektion NIS) of the German Trauma Society (DGU), Germany.
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D004632:Emergency Medical Services; D005260:Female; D005440:Fluid Therapy / Q000379:methods* / Q000401:mortality; D005858:Germany / Q000453:epidemiology; D006489:Hemostatic Techniques / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D015601:Injury Severity Score; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D010820:Physicians; D011785:Quality Assurance, Health Care; D012042:Registries; D012189:Retrospective Studies; D013997:Time Factors; D014193:Trauma Centers; D014947:Wounds and Injuries / Q000401:mortality* / Q000628:therapy*; D055815:Young Adult
keywords: Emergency medicine; Emergency physician; Fluid administration; Intubation; Paramedic; Pre-hospital care; Registry; Severely injured patients