Emergency medical services (EMS) vs non-EMS transport of critically injured patients - A prospective evaluation

Background: A previous report of 5782 trauma patients demonstrated higher mortality among those transported by emergency medical services (EMS) than among their non-EMS-transported counterparts. Hypothesis: Trauma patients who are transported by EMS and those who are not differ in the injury-to-hospital arrival time interval. Design: Prospective cohort-matched observation study. Setting: Level I trauma center, multidisciplinary study group. Patients: All non-EMS patients were matched with the next appropriate EMS patient by an investigator who was unaware of the outcome and mode of transport. Every 10th EMS patient with an Injury Severity Score (ISS) of 13 or greater was also randomly enrolled. Matching characteristics included age, ISS, mechanism of injury, head Abbreviated Injury Score, and presence of hypotension. An interview protocol was developed to determine the time of injury. Interview responses from patients, witnesses, and friends were combined with data obtained from police, sheriff, and medical examiner reports. Main Outcome Measures: Time to the hospital, mortality, morbidity, and length of stay. Results: A total of 103 patients were enrolled (38 non-EMS, 38 EMS matched, 27 random EMS). Injury time was estimated using all available data made on 100 patients (97%). Independent raters agreed in 81% of cases. Deaths, complications, and length of hospital stay were similar between the EMS- and non-EMS-transported groups. Although time intervals were similar among the groups overall, more critically injured non-EMS patients (ISS greater than or equal to 13) got themselves to the trauma center in less time than their EMS counterparts (15 minutes vs 28 minutes; P<.05). Conclusions: A multidisciplinary approach can be utilized, and an interview protocol created to determine actual time of injury. Critically injured non-EMS-transported patients (ISS greater than or equal to 13) arrived at the hospital earlier after their injuries.