Advanced prehospital resuscitative care: Can we identify trauma patients who might benefit?

Abstract

BACKGROUND:

Uncontrolled truncal hemorrhage remains the most common cause of potentially preventable death after injury. The notion of earlier hemorrhage control and blood product resuscitation is therefore attractive. Some systems have successfully implemented prehospital advanced resuscitative care (ARC) teams. Early identification of patients is key and is reliant on rapid decision making and communication. The purpose of this simulation study was to explore the feasibility of early identification of patients who might benefit from ARC in a typical US setting.

METHODS:

We conducted a prospective observational/simulation study at a level I trauma center and two associated emergency medical service (EMS) agencies over a 9-month period. The participating EMS agencies were asked to identify actual patients who might benefit from the activation of a hypothetical trauma center-based ARC team. This decision was then communicated in real time to the study team.

RESULTS:

Sixty-three patients were determined to require activation. The number of activations per month ranged from 2 to 15. The highest incidence of calls occurred between 4 pm to midnight. Of the 63 patients, 33 were transported to the trauma center. The most common presentation was with penetrating trauma. The median age was 27 years (interquartile range, 24-45 years), 75% were male, and the median Injury Severity Score was 11 (interquartile range, 7-20). Based on injury patterns, treatment received, and outcomes, it was determined that 6 (18%) of 33 patients might have benefited from ARC. Three of the patients died en-route to or soon after arrival at the trauma center.

CONCLUSION:

The prehospital identification of patients who might benefit from ARC is possible but faces challenges. Identifying strategies to adapt existing processes may allow better utilization of the existing infrastructure and should be a focus of future efforts.

LEVEL OF EVIDENCE:

Prognostic/Epidemiologic, level III.

• Authors: Ahmer Irfan, Kavina Juneja, Peter Abraham, W Andrew Smedley, Shannon W Stephens, Russell L Griffin, William Ward, Robert Hallmark, Zaffer Qasim, Shannon L Carroll, Donald Reiff, John B Holcomb, Jan O Jansen
• Journal: The journal of trauma and acute care surgery (J Trauma Acute Care Surg) Vol. 91 Issue 3 Pg. 514-520 (09 01 2021) ISSN: 2163-0763 [Electronic] United States
• PMID: 33990533 (Publication Type: Journal Article, Observational Study)
• Copyright: Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

Topics

• Adult
• Alabama (epidemiology)
• Emergency Medical Services (methods, organization & administration)
• Female
• Hemorrhage (etiology, mortality)
• Humans
• Injury Severity Score
• Male
• Middle Aged
• Needs Assessment (statistics & numerical data)
• Patient Care Team (organization & administration)
• Prospective Studies
• Resuscitation (methods)
• Trauma Centers
• Wounds and Injuries (complications, mortality, therapy)
• Young Adult