Prehospital trauma care evolution, practice and controversies: need for a review

Varghese, Mathew

doi:10.1080/17457300.2019.1708409

Cited by 9 publications

(7 citation statements)

References 100 publications

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“…The advancements in the prehospital care system may affect the injured patient's physiological parameters. Nowadays, most prehospital personnel have extensive training and skills through continuing education and national certifications and perform many interventions like airway management, bleeding control, fluid resuscitation, or advanced cardiac life support to restore deranged physiology (Varghese, 2020). As a result of evolving prehospital care services, trauma patients may be less likely to present to the hospital in the same clinical condition than found at the scene (Dinh et al, 2013; Reid et al, 2018).…”

Section: Discussionmentioning

confidence: 99%

Validation of the Trauma and Injury Severity Score for Prediction of Mortality in a Greek Trauma Population

Filippatos

Tsironi²,

Zyga³

et al. 2022

Journal of Trauma Nursing

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A total of 8,988 trauma patients were included, of whom 854 died (9.5%). The TRISS MTOS displayed excellent discrimination with an area under the curve (AUC) of 0.912 (95% CI 0.902-0.923) and comparable with TRISS NTDB (AUC = 0.908, 95% CI 0.897-0.919, p = .1195). Calibration of both models was poor (Hosmer-Lemeshow test p < .001), tending to underestimate the probability of mortality across almost all risk groups. The TRISS GrTD resulted in statistically significant improvement in discrimination (AUC = 0.927, 95% CI 0.918-0.936, p < .0001) and acceptable calibration (Hosmer-Lemeshow test p = .113). CONCLUSION:In this cohort of Greek trauma patients, the performance of the original TRISS was suboptimal, and there was no evidence that it has benefited from its latest revision. By contrast, a strong case exists for supporting a locally recalibrated version to render the TRISS applicable for mortality prediction and performance benchmarking.

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Section: Discussionmentioning

confidence: 99%

Validation of the Trauma and Injury Severity Score for Prediction of Mortality in a Greek Trauma Population

Filippatos

Tsironi²,

Zyga³

et al. 2022

Journal of Trauma Nursing

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“…In the pre-hospital setting, clinical clues aid first responders in triage efforts. 25 However, concerningly, Milling et al identified that many non-clinical factors affected decisions in the provision of pre-hospital care for potentially critically ill patients. 26 We demonstrated that patients who decline to use protective devices have increased risk of pre-hospital and emergency department hemodynamic instability.…”

Section: Discussionmentioning

confidence: 99%

“…These observations are especially important as they relate to decisions regarding potential transport to a higher level of trauma facility for patients without protective devices. 25,27 Although seat belts do diminish the risk of life-threatening brain injury, they also may induce a unique pattern of injuries or bruising noted as a "seat belt sign" which is associated with an increased rate of chest wall trauma. These is in keeping with our data wherein we demonstrated that use of protective devices was associated with increased rates of chest trauma (28% vs 20%).…”

Section: Discussionmentioning

confidence: 99%

The Impact of Protective Devices Across the Spectrum of Trauma Care and Across Racial Groupings

Montas

Nwaiwu

Stephen

et al. 2022

The American Surgeon™

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Introduction Protective devices such as seat belts and helmets save lives. Most studies only address one aspect of the injury profile – compliance or mortality – not the entire spectrum of trauma care, and little attention is paid to racial differences in the use or impact of protective devices. Methods Patients with blunt mechanisms where using protective devices would be expected were included and were divided into utilizing (P) vs not utilizing protection (Non-P). Chart review included demographics, injuries sustained, hemodynamics, and blood alcohol level. Outcomes included need for emergent operation, complications and death. Results Non-P patients were more likely male, presented at night and intoxicated. Highest risk behavior (intoxicated Non-P) presented at night (25.7% of nighttime presentations), and rarely during daytime (6.7% daytime presentations). Non-P were more likely hypotensive and sustain a traumatic brain injury. No race related differences were noted among young patients. Among older (>/=50 years) patients, White patients were least likely Non-P and least likely presented at night. Non-P required more emergent operative intervention, ICU admission, and longer hospital stay. Overall, Non-P was associated with increased risk of death (OR = 1.6 (95% CI = 1.28 – 2.11). Conclusion Given unique age and racial differences, we advocate for culturally and age specific public service campaigns.

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“…Also, in case of an MCI incident, capacity aspects of MCI management, in relation to the number of victims, the scale of the MCI, environmental characteristics, distance to the nearby trauma center, the medical capacity in terms of hospital beds and ambulances, and (pre)hospital staff competencies, might be relevant on the choice for the preferred model. 15,16 However, there is large consensus that prehospital treatment and transfer time of victims should be as short as possible, in favor of scoop and run as the standard approach. 17 This approach is only feasible as long as the medical chain can handle the influx of casualties.…”

Section: Discussionmentioning

confidence: 99%

Medical Coordination Rescue Members’ and Ambulance Nurses’ Perspectives on a New Model for Mass Casualty and Disaster Management and a Novel Terror Attack Mitigation Approach in the Netherlands: A Qualitative Study

Berben

Vloet

Lischer

et al. 2021

Prehosp. Disaster med.

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Introduction: Mass-casualty incidents (MCIs), specifically incidents with chemical, biological, radiological, and nuclear agents (CBRN) or terrorist attacks, challenge medical coordination, rescue, availability, and adequate provision of prehospital and hospital-based emergency care. In the Netherlands, a new model for Mass Casualty and Disaster Management (MCDM) along with a Terror Attack Mitigation Approach (TAMA) was introduced in 2016. Study Objective: The objective of this study was to provide insight in the first experiences of health policy advisors and managers with a medical rescue coordinator and ambulance nursing background regarding the new MCDM and TAMA in order to identify strengths and pitfalls in emergency preparedness and to provide recommendations for improvement. Methods: The study had a qualitative design and was performed from January 2017 through June 2018. Purposeful sampling was used and the inclusion comprehended health policy advisors and managers with a medical rescue coordinator and ambulance nursing background involved in emergency preparedness. The respondents were interviewed semi-structured and the researchers used a topic list that was based on the literature and content of the newly introduced model and approach. All interviews were typed out verbatim and qualitative content analyzing was used in order to identify relevant themes. Results: Respondents based their perceptions on large-scale training exercises, as MCDM and TAMA were not yet used during MCIs. Perceived issues of MCDM were the two-tiered triage system, the change in focus from “stay and play” towards “scoop and run,” difficulties with new tasks and roles of professionals, and improvement in material provision. Regarding TAMA, all respondents supported the principles (do the most for the most; scoop and run; acceptable personal risk; never walk alone; and standard operational procedure); however, the definitions were lacking clarity while the awareness of optimal personal safety of professionals was absent. As there are currently regional differences in the level of implementation of MCDM and TAMA, this may pose a risk for an optimal inter-regional collaboration. Conclusion: The conclusions refer to experiences of professionals in the Netherlands. Elements of the MCDM and TAMA were highly appreciated and seemed to improve emergency preparedness, while other aspects needed further attention, training, and integration in daily routine. The Netherlands’ MCDM model and TAMA will need continuous systematic evaluation based on (inter)national performance criteria in order to underpin the useful and effective elements and to improve the observed pitfalls in emergency preparedness.

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Prehospital trauma care evolution, practice and controversies: need for a review

Cited by 9 publications

References 100 publications

Validation of the Trauma and Injury Severity Score for Prediction of Mortality in a Greek Trauma Population

Validation of the Trauma and Injury Severity Score for Prediction of Mortality in a Greek Trauma Population

The Impact of Protective Devices Across the Spectrum of Trauma Care and Across Racial Groupings

Medical Coordination Rescue Members’ and Ambulance Nurses’ Perspectives on a New Model for Mass Casualty and Disaster Management and a Novel Terror Attack Mitigation Approach in the Netherlands: A Qualitative Study

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