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Prehospital analysis of northern trauma outcome measures: the PHANTOM study
  1. Christopher A Smith1,2,
  2. Richard D Hardern3,
  3. Simon LeClerc2,
  4. Richard J Howes2
  1. 1Emergency Department, James Cook University Hospital, Middlesbrough, UK
  2. 2Research and Development team, Great North Air Ambulance Service, The Imperial Centre, Darlington, UK
  3. 3Emergency Department, University Hospital of North Durham, Durham, UK
  1. Correspondence to Dr Christopher A Smith, Emergency Department, James Cook University Hospital, Middlesbrough TS4 3BW, UK; Chrissmith30{at}me.com

Abstract

Objective To compare the mortality and morbidity of traumatically injured patients who received additional prehospital care by a doctor and critical care paramedic enhanced care team (ECT), with those solely treated by a paramedic non-ECT.

Methods A retrospective analysis of Trauma Audit and Research Network (TARN) data and case note review of all severe trauma cases (Injury Severity Score ≥9) in North East England from 1 January 2014 to 1 December 2017 who were treated by the North East Ambulance Service, the Great North Air Ambulance Service or both. TARN methods were used to calculate the number of unexpected survivors or deaths in each group (W score (Ws)). The Glasgow Outcome Scores were contrasted to evaluate morbidity.

Results The ECT group treated 531 patients: there were 17 unexpected survivors and no unexpected deaths. The non-ECT group treated 1202 patients independently: there were no unexpected survivors and 31 unexpected deaths. The proportion of patients requiring critical care interventions differed between the two groups 49% versus 33% (CI for difference 12% to 20%). In the ECT group, the Ws was 3.22 (95% CI 0.79 to 5.64). In the non-ECT group, the Ws was −2.97 (95% CI −1.22 to −4.71). The difference between the Ws was 6.18 (95% CI 3.19 to 9.17). There was no evidence of worse morbidity in the ECT group.

Conclusion This is the first UK ECT service to demonstrate a risk-adjusted mortality benefit in trauma patients with no detriment in morbidity: our results demonstrate an additional 3.22 survivors per 100 severe trauma casualties when treated by an ECT. The authors encourage other ECT services to conduct similar research.

  • prehospital care, doctors In Phc
  • prehospital care, helicopter retrieval
  • trauma, research

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Footnotes

  • Patient consent for publication Not required.

  • Contributors CAS devised the study, collated TARN prehospital and hospital data, performed statistical analysis and wrote the article. RDH advised with statistical analysis and reviewed the article. SL reviewed the article. RJH collated data and reviewed the article. Sophie Jones aided with data collection via TARN.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests SL is a Medical Director of GNAAS and EM consultant at JCUH. CAS is Deputy Medical Director and EM consultant at JCUH. RJH is PHEM and EM consultant at GNAAS and RVI.

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

  • Collaborators Sophie Jones (TARN analyst)

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