Time important in transporting critically injured to trauma centers

e patients with intravenous fluids or other means, then bring them to the hospital, otherwise known as "stay and play."

The best way for EMS to treat patients probably varies with the setting and circumstances of injury, Cornwell says, be it a gunshot wound vs. injuries sustained in an auto crash, for example. Proximity to a trauma center also is a factor.

"Paramedics adhere to pre-established protocols in transporting trauma patients, so our studies showed an amazing consistency in the injury-to-hospital-arrival time interval regardless of the severity of injury," Cornwell says. "By contrast, in the non-EMS group, the more critical the injury, the quicker patients got themselves to the emergency department, almost as if they recognized the severity of their own injuries."

For the current study, patients were enrolled between January and October 1997. Estimated time of injury and outcome for 38 patients who arrived at the center by private means were matched to those of 38 patients of similar ages and injuries who were transported by EMS. Twenty-seven random patients transported by EMS also were studied as a control. The general population was approximately 85 percent male, 80 percent Hispanic and 10 percent African-American.

The majority of patients had an injury severity score (ISS) of 13 or more on a 75-point scale. The ISS is calculated by dividing the body into quadrants and assigning a number to each quadrant based on severity of the injuries in each, then squaring those numbers and adding them together. An example of an ISS of 13 would be a gunshot wound to the chest and abdomen with injuries to the lung and a hemothorax (blood in the chest) and an injury to a peripheral segment of the liver. Researchers created a model to assess the time of injury in each patient by interviewing the patient and any witnesses or friends, and combine their answers with data obtained from police, sheriff and medical examiner reports.

Contact: Karen Infeld
Johns Hopkins Medical Institutions

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