Time important in transporting critically injured to trauma centers

In the continuing debate among emergency medical services (EMS) personnel regarding the best pre-hospital management for trauma patients, a new study by Johns Hopkins and the University of Southern California raises the bar on the importance of time.

In a study of 103 people, the most critically injured patients transported by private means arrived at Los Angeles County (LAC) + USC Medical Center, a Level 1 trauma center, in nearly half the time of their counterparts transported by EMS -- an average of 15 minutes between time of injury and hospital arrival vs. 28 minutes. Despite this difference, deaths, complications and length of hospital stay were similar between the EMS and non-EMS transported patients. There was, however, a trend toward better outcomes for those who arrived at the trauma center more quickly following injury.

A 1996 retrospective study of 5,782 patients admitted to that center over a two-year period found that trauma patients transported by EMS had death rates twice as high as those transported by private means (28.2 percent vs. 17.9 percent).

Results of the current study -- the first to look at the non-EMS group in detail -- were published in the March issue of Archives of Surgery.

"One might think that the importance of time is obvious, intuitive and, thus, not worth studying," says Edward E. Cornwell, M.D., lead author of the study and chief of trauma at Hopkins. "But just two years ago, we heard reports that Princess Diana was at the scene of the accident for 45 minutes and had a slow transport to the hospital."

About 4 to 15 percent of all major trauma patients arrive at a sampling of large, urban trauma centers by means other than EMS, Cornwell says. These patients represent the purest form of "scoop and run" the philosophy that says EMS should rush patients straight to the hospital rather than first treating them on-scene. Others believe EMS should stay on scene a while and resuscitat

Contact: Karen Infeld
Johns Hopkins Medical Institutions

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