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Trauma patients who suddenly deteriorate in the care of paramedics: an Australian case

04 November 2011
Features
02 November 2011
Volume 3 · Issue 11

Abstract

Investigations into the trauma patient who suddenly deteriorates while in the care of paramedics, either on scene or during transport to hospital, is limited. The objective of the study was to determine the incidence, physiological criteria for sudden deterioration, and outcome of patients who suddenly deteriorated during paramedic care. Methods: this is a secondary data analysis of an existing prehospital-based trauma dataset. The sudden deterioration dataset had been created previously by linking twelve months (2002) of an Australian Ambulance Service's trauma data with a State Trauma Registry. The sudden deterioration dataset was interrogated using predefined criteria to identify patients who suddenly deteriorated in the presence of paramedics, either on scene or enroute to hospital. Results: there were 239 patients who met the criteria for sudden deterioration, amounting to 0.45% of the total number of trauma patients transported or seen by the Victorian Ambulance Services for 2002. Four patients who suddenly deteriorated did not meet the criteria for prehospital potential major trauma. Conclusion: this study suggests that the incidence of trauma patients suddenly deteriorating in the presence of paramedics is very low and that increasing the total out-of-hospital time to get these patients to an appropriate level trauma service does not adversely affect their mortality outcome.

Investigations into the trauma patient who suddenly deteriorates while in the care of a paramedic crew, either on scene or during transport to hospital, is limited. There is no evidence-based guide identifying the categories of trauma patients who are more likely to deteriorate suddenly in the presence of paramedics. Nor is it clear what the appropriate triage options should be for those patients: transport to a Level 1 trauma centre or diversion to the closest hospital.

Previous trauma-related studies have investigated such issues as scene times (Feero et al, 1995; Goodacre et al, 1997; Eckstein and Alo, 1999; Altintas and Bilir, 2001; Al-Ghamdi, 2002; Birk and Henriksen, 2002; Carr et al, 2006; Gonzalez et al, 2008; Gonzalez et al, 2009); total out-of-hospital time (Feero et al, 1995; Al-Ghamdi, 2002; Carr et al, 2006; Newgard et al, 2010; Osterwalder, 2002); out-of-hospital time, and effect on mortality (Osterwalder, 2002; Newgard et al, 2010), and the effectiveness of treating trauma patients in Level 1 trauma centres (Cooper et al, 1998; Freeman et al, 2006; MacKenzie et al, 2006; Nirula and Brasel, 2006; Papa et al, 2006).

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Emergency Medicine
Paramedics
Sudden Deterioration
Trauma