PREHOSPITAL CARE

Prehospital trauma management: a national study of paramedic activities

S Sukumaran¹, J M Henry², D Beard², R Lawrenson³, M W G Gordon⁴, J J O’Donnell⁵ and A J Gray¹

¹ Emergency Department, Royal Infirmary of Edinburgh, UK
² Scottish Trauma Audit Group
³ Scottish Ambulance Service
⁴ Emergency Department, Southern General Hospital, Glasgow, UK
⁵ Emergency Department, University College Hospital, Galway, Ireland

Correspondence to:
Correspondence to:
Dr S Sukumaran
Emergency Department, Royal Infirmary of Edinburgh, Old Dalkeith Road, Little France, Edinburgh EH16 4SU, UK; s_sukumaran{at}hotmail.com

Objectives: The benefits of prehospital trauma management remain controversial. This study aimed to compare the processes of care and outcomes of trauma patients treated by paramedics, who are trained in advanced prehospital trauma care, with those treated by ambulance technicians.

Methods: A six year prospective study was conducted of adult trauma patients attended to by the Scottish Ambulance Service and subsequently admitted to hospital. Prehospital times, interventions, triage, and outcomes were compared between patients treated by paramedics and those treated by technicians.

Results: Paramedics attended more severely injured patients (16.5% versus 13.9%, p<0.001); they attended a higher proportion of patients with penetrating trauma (6.6% versus 5.7%, p = 0.014) and had longer prehospital times. Patients managed by paramedics were more likely to be taken to the intensive care unit, operating theatre or mortuary, (11.2% versus 7.8%, p<0.001) and had higher crude mortality rates (5.3% versus 4.5%, p = 0.07). However, no difference in mortality between the two groups was noted when corrected for age, Glasgow coma score and injury severity score.

Conclusions: This large scale national study shows that paramedics show good triage skills and clinical judgement when managing trauma patients. However, the value of the individual interventions they perform could not be ascertained. Further controlled trials are necessary to determine the true benefits of advanced prehospital trauma life support.

Abbreviations: ISS, injury severity score; GCS, Glasgow coma score; ED, emergency department; STAG, Scottish Trauma Audit Group; SMR, standardised mortality ratios; PRF, patient report form

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