Preventable dealth evaluation of the appropriateness of the on-site trauma care provided by Urgences-Santé physicians.
Royal College of Physicians and Surgeons of Canada. Annual meeting. Toronto ON CAN, 1994/09.
The study is based on 44 preventable deaths occurring in a cohort of 360 patients with major trauma.
These cases were reviewed by a committee of nine experts.
The mean Injury Severity Score (ISS) was 28, and most cases had injuries to the head/neck (68%) and chest (64%). The mean (±SD) observed prehospital times, and those considered the maximum allowable by the committee, were 40.6 ± 12.0 minutes for head/neck injuries and 23.9 ± 12.2 minutes for chest injuries (p<0.05).
Intravenous (IV) lines were started in 38 (86%) of the patients.
The committee classified this procedure as harmful for 16 (42%) and neutral for 19 (50%). Among the 18 (46%) that were intubated, this intervention was considered harmful for 17% and neutral for 39%. In two of the three patients for whom a pneumatic antishock garment was applied, this procedure was considered harmful.
Of the 34 patients that required direct transport at a level I trauma center, 50% were transferred to such a hospital.
These results show significant prehospital delays and high rates of inappropriate IV line initiation and intubation in trauma patients receiving on-site care by physicians.
We conclude that prehospital care protocols for trauma patients should emphasize prompt transport and specific on-site care algorithms.
Mots-clés Pascal : Canada, Amérique du Nord, Amérique, Evaluation, Pratique professionnelle, Secours première urgence, Période préhospitalière, Mortalité, Soin, Traumatisme, Homme
Mots-clés Pascal anglais : Canada, North America, America, Evaluation, Professional practice, First emergency care, Prehospital period, Mortality, Care, Trauma, Human
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Cote : 96-0081017
Code Inist : 002B27B14C. Création : 199608.