title: Are prehospital deaths from trauma and accidental injury preventable? A direct historical comparison to assess what has changed in two decades.
abstract: OBJECTIVE
  In 1994, Hussain and Redmond revealed that up to 39% of prehospital deaths from accidental injury might have been preventable had basic first aid care been given. Since then there have been significant advances in trauma systems and care. The exclusion of prehospital deaths from the analysis of trauma registries, giv en the high rate of those, is a major limitation in prehospital research on preventable death. We have repeated the 1994 study to identify any changes over the years and potential developments to improve patient outcomes.
  
  
  METHODS
  We examined the full Coroner's inquest files for prehospital deaths from trauma and accidental injury over a three-year period in Cheshire. Injuries were scored using the Abbreviated-Injury-Scale (AIS-1990) and Injury Severity Score (ISS), and probability of survival estimated using Bull's probits to match the original protocol.
  
  
  RESULTS
  One hundred and thirty-four deaths met our inclusion criteria; 79% were male, average age at death was 53.6 years. Sixty-two were found dead (FD), fifty-eight died at scene (DAS) and fourteen were dead on arrival at hospital (DOA). The predominant mechanism of injury was fall (39%). The median ISS was 29 with 58 deaths (43%) having probability of survival of >50%. Post-mortem evidence of head injury was present in 102 (76%) deaths. A bystander was on scene or present immediately after injury in 45% of cases and prior to the Emergency Medical Services (EMS) in 96%. In 93% of cases a bystander made the call for assistance, in those DAS or DOA, bystander intervention of any kind was 43%.
  
  
  CONCLUSIONS
  The number of potentially preventable prehospital deaths remains high and unchanged. First aid intervention of any kind is infrequent. There is a potentially missed window of opportunity for bystander intervention prior to the arrival of the ambulance service, with simple first-aid manoeuvres to open the airway, preventing hypoxic brain injury and cardiac arrest.
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: D000056:Accident Prevention / Q000379:methods; D000059:Accidents / Q000401:mortality* / Q000706:statistics & numerical data; D000328:Adult; D000552:Ambulances / Q000706:statistics & numerical data*; D001344:Autopsy; D004632:Emergency Medical Services / Q000706:statistics & numerical data / Q000639:trends; D005260:Female; D005392:First Aid / Q000401:mortality / Q000706:statistics & numerical data / Q000639:trends; D007722:Health Knowledge, Attitudes, Practice; D006323:Heart Arrest / Q000401:mortality* / Q000628:therapy; D006801:Humans; D008020:Life Support Care; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016019:Survival Analysis; D015599:Trauma Severity Indices; D006113:United Kingdom / Q000453:epidemiology; D014947:Wounds and Injuries / Q000401:mortality* / Q000628:therapy
keywords: Injury; Prehospital; Preventable death; Trauma