title: Prehospital deaths from trauma: Are injuries survivable and do bystanders help?
abstract: OBJECTIVE
  Deaths from trauma occurring in the prehospital phase of care are typically excluded from analysis in trauma registries. A direct historical comparison with Hussain and Redmond's study on preventable prehospital trauma deaths has shown that, two decades on, the number of potentially preventable deaths remains high. Using updated methodology, we aimed to determine the current nature, injury severity and survivability of traumatic prehospital deaths and to ascertain the presence of bystanders and their role following the point of injury including the frequency of first-aid delivery.
  
  
  METHODS
  We examined the Coroners' inquest files for deaths from trauma, occurring in the prehospital phase, over a three-year period in the Cheshire and Manchester (City), subsequently referred to as Manchester, Coronial jurisdictions. Injuries were scored using the Abbreviated-Injury-Scale (AIS-2008), Injury Severity Score (ISS) calculated and probability of survival estimated using the Trauma Audit and Research Network's outcome prediction model.
  
  
  RESULTS
  One hundred and seventy-eight deaths were included in the study (one hundred and thirty-four Cheshire, forty-four Manchester). The World Health Organisation's recommendations consider those with a probability of survival between 25-50% as potentially preventable and those above 50% as preventable. The median ISS was 29 (Cheshire) and 27.5 (Manchester) with sixty-two (46%) and twenty-six (59%) respectively having a probability of survival in the potentially preventable and preventable ranges. Bystander presence during or immediately after the point of injury was 45% (Cheshire) and 39% (Manchester). Bystander intervention of any kind was 25% and 30% respectively. Excluding those found dead and those with a probability of survival less than 25%, bystanders were present immediately after the point of injury or "within minutes" in thirty-three of thirty-five (94%) Cheshire and ten of twelve (83%) Manchester. First aid of any form was attempted in fourteen of thirty-five (40%) and nine of twelve (75%) respectively.
  
  
  CONCLUSIONS
  A high number of prehospital deaths from trauma occur with injuries that are potentially survivable, yet first aid intervention is infrequent. Following injury there is a potential window of opportunity for the provision of bystander assistance, particularly in the context of head injury, for simple first-aid manoeuvres to save lives.
authors.affiliation: Humanitarian and Conflict Response Institute, Ellen Wilkinson Building, Oxford Road, University of Manchester, Manchester M15 6JA, UK. Electronic address: govind.oliver@manchester.ac.uk.
authors.forename: G J
authors.initials: GJ
authors.lastname: Oliver
authors.affiliation: Humanitarian and Conflict Response Institute, Ellen Wilkinson Building, Oxford Road, University of Manchester, Manchester M15 6JA, UK.
authors.forename: D P
authors.initials: DP
authors.lastname: Walter
authors.affiliation: Humanitarian and Conflict Response Institute, Ellen Wilkinson Building, Oxford Road, University of Manchester, Manchester M15 6JA, UK.
authors.forename: A D
authors.initials: AD
authors.lastname: Redmond
mesh_terms: D015998:Abbreviated Injury Scale; D000328:Adult; D000368:Aged; D000552:Ambulances; D002423:Cause of Death; D004632:Emergency Medical Services / Q000592:standards / Q000639:trends; D005260:Female; D005392:First Aid / Q000592:standards / Q000639:trends; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors; D006113:United Kingdom / Q000453:epidemiology; D014947:Wounds and Injuries / Q000401:mortality* / Q000628:therapy
keywords: Bystander; Injury; Prehospital; Preventable death; Survivability; Trauma