@article {Rouseemermed-2016-206329, author = {Colin Rouse and Jefferson Hayre and James French and Jacqueline Fraser and Ian Watson and Susan Benjamin and Allison Chisholm and Beth Sealy and Mete Erdogan and Robert S Green and George Stoica and Paul Atkinson}, title = {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?}, elocation-id = {emermed-2016-206329}, year = {2017}, doi = {10.1136/emermed-2016-206329}, publisher = {British Association for Accident and Emergency Medicine}, 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{\textquoteright}s exact test and the Student{\textquoteright}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.}, issn = {1472-0205}, URL = {https://emj.bmj.com/content/early/2017/11/04/emermed-2016-206329}, eprint = {https://emj.bmj.com/content/early/2017/11/04/emermed-2016-206329.full.pdf}, journal = {Emergency Medicine Journal} }