EMS might be a detriment to surviving trauma

[kevkei]

...

....RESULTS: The two groups were similar with regard to mechanism of injury and the need for surgery or intensive care unit admission. The crude mortality rate was 9.3% in the EMS group and 4.0% in the non-EMS group (relative risk, 2.32; P < .001). After adjustment for ISS, the relative risk was 1.60 (P = .002). Subgroup analysis showed that among patients with ISS greater than 15, those in the EMS group had a mortality rate twice that of those in the non-EMS group (28.8% vs 14.1%). After controlling for confounding factors, the adjusted mortality among patients with ISS greater than 15 was 28.2% for the EMS group and 17.9% for the non-EMS group (P < .001

Now, one has to read that the ISS was almost 10% more than the non-EMS group.

R/r 911

Not only is the ISS higher in EMS patients, it was significantly higher (63.45%) than the ISS of the non EMS patients. (Thus they have an automatically higher mortality rate.

As well, look at the numbers of enrolled patients - 4856 EMS patients with 926 non-EMS patients (5.2 times the amount of EMS patients). You can't compare these two groups as you need to have equal numbers to account for any other factors. What would the results have been if they only looked at 926 EMS patients to compare with the 926 non-EMS patients?

[Ridryder 911]

As well, this would had been a simple statistic study that could been performed in a matter of a few minutes to hours. Each Level I Trauma Center is required to have a Trauma Registry that has filters to be able to compose and analyze any information such as TRISS, age, GLASGOW, etc.. for a comparrision analyses study. It is routinely performed for check and balances for TQI, for most EMS Services as well as re-accreditation of the T.C. on outcome events.

So, again a published nothing.. again, that appears to be tainted of having biased opinions.

R/r 911

[ERDoc]

Not only is the ISS higher in EMS patients, it was significantly higher (63.45%) than the ISS of the non EMS patients. (Thus they have an automatically higher mortality rate.

As well, look at the numbers of enrolled patients - 4856 EMS patients with 926 non-EMS patients (5.2 times the amount of EMS patients). You can't compare these two groups as you need to have equal numbers to account for any other factors. What would the results have been if they only looked at 926 EMS patients to compare with the 926 non-EMS patients?

I think you guys are misinterpreting some of the data. They accounted for differences in ISS (as well as other confounding variables) and there was still a statistically significant difference, though not as big as when you compare the crude groups. Though I haven't read the original article, just the abstract, I don't think we can come to the conclusion that the ISS was almost 10% more in the EMS subgroup. The abstract does not tell us what the ISS was for each subgroup. You can compare subgroups with unequal numbers. That is the purpose of using statistics. They allow you to mathematically and scientifically compare the two groups. I don't think anyone is saying that this is due to EMS ability, but more likely, as others on here have said, time to get the person to the trauma center. Another study showed that in pts who had equal transport times (EMS vs. nonEMS) there were equal outcomes. It also showed that in pts with ISS greater than 12, it took them longer to get to the hospital by EMS than it did by Homeboy Ambulance, but it did not look at the differences in outcomes of these pts.

http://www.ncbi.nlm.nih.gov/entrez/query.f...t_uids=10722034

There was also another study that showed that pts who were transported to a nontrauma center hospital first did worse than those who were taken directly to the trauma center.

http://www.ncbi.nlm.nih.gov/entrez/query.f...st_uids=9291375

[scope2776]

obviously the answer is to give Paramedics more tools to play with so that we can initiate definitive care at the moment of patient contact, cause if we can't really do anything to help the patient then we are no better than homeboy ambulance company.

[ERDoc]

obviously the answer is to give Paramedics more tools to play with so that we can initiate definitive care at the moment of patient contact, cause if we can't really do anything to help the patient then we are no better than homeboy ambulance company.

Read my post above. From what the literature is showing (albeit limited), what a trauma pt needs a surgeon (grits teeth) as quickly as possible. Even pts who were taken to outlying hospitals did worse than those taken to the trauma center. The way I take it is that less playing and more rapid transport to a trauma center is what the pt needs. Unfortunetly the outlying hospitals are bound by law to stabilize the pt prior to transport, which may not be in the pts best interest (again, from the limited literature). No matter how progressive your service is, I doubt you will be doing elaps or craniotomies, so more toys does not seem like the answer.

[CBEMT]

obviously the answer is to give Paramedics more tools to play with so that we can initiate definitive care at the moment of patient contact

Please god tell me this was sarcasm.

[tniuqs]

Passes over Versed to ERDoc for TMJ!

I would appreciated reading those new studies: but Questions that come to mind:

What type of Scoring or Patient Severity would be the criteria?

What could be done better? in the back of the rig.

In these "Load and Go Senarios" what evidence based medical research has been done to date, that could improve chaces of survival and treat those patients more effectivly enroute to a trauma center from a outlying hospital?

Could some form of Hypothermia treatment may have a place in the future?

Did the Military do any studies in Viet Nam or the Faulklands in this regard?

I dunno and where would one even try Gooling?

cheers

[AnthonyM83]

Many studies are very legitimate and follow close scientific methodologies, and I honor those that perform such. Unfortunately, there are as many poor ones that discredits and sometimes make bigger headlines.

Medical studies are essential for us to be able deliver the best care. For it is the best scientific method available. With that saying it is the responsibility of the reader not just to read a study but to check and have a understanding of multiple methods of the study before reaching a final opinion.

R/r 911

Okay, I'm just getting back to this post. So, my question is now: How does the study I posted fall into that category of a bad study? I mean I certainly understand there can be poor studies and poor conclusions. The study seems limited, but I don't think that alone makes it a bad study. Just because they identified a problem, but didn't solve it doesn't mean it's bad study.

Obviously the study needs to be reproduced and after a few of those, we can take it as fact that private transport increases survival. Then there needs to be SEVERAL other studies from different funding sources to find out WHY that is.

I too look at studies with skepticism, though I've made mistakes before (like with the Trendelenberg / Blood Pressure thread) and believed to readily, but this study isn't that far out. If what a trauma patient usually needs is surgical steel, then it makes sense that long delays in getting that definitive care (as occur when you call 911 versus homeboy ambulance) might decrease survival.

I'd rather see this study as a chance to explore what EMS can do better....not just write it off as a bad study.

[ERDoc]

To look for studies go to pubmed.com and search all you want. It is a fairly comprehensive database of literature.