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Abstract
Aims and Objectives Major trauma is a leading cause of death and disability worldwide, and many healthcare systems seek to improve outcomes following severe injury with provision of pre-hospital critical care (PHCC). Research has focussed on the efficacy of PHCC, but less is known about how the structure of these services may influence their response to major trauma. This study assessed the association between likelihood of PHCC response in major trauma and factors important in their planning and development: geographic isolation, time of day, and tasking mechanism.
Method and Design A local trauma registry, supported with data from the Trauma Audit and Research Network alongside pre-hospital management, identified patients sustaining major trauma (with Injury Severity Score ≥9), admitted to Major Trauma Centres in the North of England. Data was extracted on location and time of incident, mechanism of injury, on-scene times, and presence or absence of PHCC team. An isochrone map was constructed for 30-minute intervals to regional Major Trauma Centres to define geographic isolation. Univariate logistic regression compared likelihood of pre-hospital critical care response to that of conventional ambulance response for varying degrees of geographic isolation, day or night period, and mechanism of injury, and multiple linear regression assessed the association between geographic isolation, service response and on-scene time.
Results and Conclusion 2987 incidents were included, 22% attended by PHCC teams. Compared to conventional ambulance services, PHCC teams were more likely to respond major trauma in areas of greater geographic isolation (OR 2.10, 95% CI 1.22-3.48), p=0.005). There were significant differences in the mechanism of injury attended and no significant difference in likelihood of PHCC response by day or night period. PHCC team response and increasing geographic isolation was associated with longer on-scene times (p <0.005).
PHCC teams are more likely to respond in areas of greater geographic isolation and have the potential to mitigate geographic inequalities.
