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A traumatic tale of two cities: does EMS level of care and transportation model affect survival in patients with trauma at level 1 trauma centres in two neighbouring Canadian provinces?
  1. Colin Rouse1,2,
  2. Jefferson Hayre1,3,
  3. James French4,5,
  4. Jacqueline Fraser6,
  5. Ian Watson5,
  6. Susan Benjamin5,
  7. Allison Chisholm5,
  8. Beth Sealy7,
  9. Mete Erdogan7,
  10. Robert S Green7,8,
  11. George Stoica9,
  12. Paul Atkinson4,5
  1. 1Dalhousie Medicine New Brunswick, Saint John, New Brunswick, Canada
  2. 2Department of Family Medicine, Dalhousie University, Saint John Regional Hospital, Saint John, New Brunswick, Canada
  3. 3Department of Family Medicine, McGill University, Jewish General Hospital, Montreal, Quebec, Canada
  4. 4Department of Emergency Medicine, Dalhousie University, Saint John Regional Hospital, Saint John, New Brunswick, Canada
  5. 5New Brunswick Trauma Program, Saint John, New Brunswick, Canada
  6. 6Department of Emergency Medicine, Saint John Regional Hospital, Saint John, New Brunswick, Canada
  7. 7Nova Scotia Department of Health and Wellness, Trauma Nova Scotia, Halifax, Nova Scotia, Canada
  8. 8Department of Critical Care, Dalhousie University, Halifax, Nova Scotia, Canada
  9. 9Research Services, Horizon Health Network, Saint John, New Brunswick, Canada
  1. Correspondence to Dr Colin Rouse, Department of Family Medicine, Dalhousie University, Saint John Regional Hospital, Saint John, NB E2K 5E2, New Brunswick, Canada; colin.rouse{at}dal.ca

Abstract

Background Two distinct Emergency Medical Services (EMS) systems exist in Atlantic Canada. Nova Scotia operates an Advanced Emergency Medical System (AEMS) and New Brunswick operates a Basic Emergency Medical System (BEMS). We sought to determine if survival rates differed between the two systems.

Methods This study examined patients with trauma who were transported directly to a level 1 trauma centre in New Brunswick or Nova Scotia between 1 April 2011 and 31 March 2013. Data were extracted from the respective provincial trauma registries; the lowest common Injury Severity Score (ISS) collected by both registries was ISS≥13. Survival to hospital and survival to discharge or 30 days were the primary endpoints. A separate analysis was performed on severely injured patients. Hypothesis testing was conducted using Fisher’s exact test and the Student’s t-test.

Results 101 cases met inclusion criteria in New Brunswick and were compared with 251 cases in Nova Scotia. Overall mortality was low with 93% of patients surviving to hospital and 80% of patients surviving to discharge or 30 days. There was no difference in survival to hospital between the AEMS (232/251, 92%) and BEMS (97/101, 96%; OR 1.98, 95% CI 0.66 to 5.99; p=0.34) groups. Furthermore, when comparing patients with more severe injuries (ISS>24) there was no significant difference in survival (71/80, 89% vs 31/33, 94%; OR 1.96, 95% CI 0.40 to 9.63; p=0.50).

Conclusion Overall survival to hospital was the same between advanced and basic Canadian EMS systems. As numbers included are low, individual case benefit cannot be excluded.

  • trauma
  • prehospital care
  • emergency care systems, advanced practitioner
  • emergency care systems, primary care

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Footnotes

  • Contributors All authors were involved in the planning of the research. The manuscript proposal was written by CR and JH under the guidance of JFrench, PA and RG. Navigation of the trauma systems in each province and planning for collaboration was facilitated by IW, SB, ME and RG. Data acquisition was performed by BS and AC. Statistical support was provided by GS. Overall co-ordination was performed by JFraser. The manuscript was written by CR with revisions provided by ME, PA, JH, JFrench, IW, SB and RG. All authors approved the final manuscript.

  • Funding The two primary authors received funding from Dalhousie University Faculty of Medicine New Brunswick. The Summer Student Research Program Studentship allowed them to complete research during a summer session of their undergraduate medical education. The study sponsor had no role in the study design; in the collection, analysis and interpretation of the data; in the writing of the report; or in the decision to submit the paper for publication. IW reports a potential competing interest from the New Brunswick Trauma Program. During the conduct of the study, he had a salaried position with the New Brunswick Trauma Program. SB reports a potential competing interest from the New Brunswick Trauma Program. During the conduct of the study, she had a salaried position with the New Brunswick Trauma Program.

  • Competing interests IW reports a potential competing interest from the NB Trauma Program. During the conduct of the study he had a salaried position with the New Brunswick Trauma Program. SB reports a potential competing interest from the NB Trauma Program. During the conduct of the study she had a salaried position with the New Brunswick Trauma Program.

  • Patient consent Detail has been removed from this case description/these case descriptions to ensure anonymity. The editors and reviewers have seen the detailed information available and are satisfied that the information backs up the case the authors are making.

  • Ethics approval Horizon Health Network Research Ethics Board, Nova Scotia Health Authority Research Ethics Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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