Regional retrospective observational analysis of the impact of enhanced care teams on trauma morbidity and mortality outcomes

TL;DR

This study shows that trauma patients treated by enhanced care teams in the UK had better survival rates compared to those receiving standard paramedic care.

Contribution

The study provides the first regional evidence of improved trauma survival linked to enhanced care teams in the UK.

Findings

ECT-treated trauma patients had a 69 excess survival compared to -57 in non-ECT groups.

The Ws statistic showed a 5.33 difference in mortality favoring ECT care.

No significant difference in morbidity was found between ECT and non-ECT groups.

Abstract

In the UK, prehospital enhanced care teams (ECT) including Ground Emergency Medical Services or Helicopter Emergency Medical Services are staffed by doctors and critical care paramedics. To date, it has remained unclear whether the advanced interventions that can be delivered by an ECT generate demonstrable benefit in patient outcome. This study compares the morbidity and mortality of injured patients who received ‘standard’ paramedic-only care with those who were attended to additionally, or exclusively, by an ECT, comprising Pre-Hospital Emergency Medicine consultant and critical care paramedic.

In collaboration with the Northern Trauma Network, a retrospective analysis of Trauma Audit and Research Network (TARN) data and case note review of all severe trauma cases (Injury Severity Score ≥ 9) in Cumbria and the North East of England, between 1 January 2010 to 31 December 2022 was completed. Patients treated by the North East, North West ambulance service and Great North Air Ambulance Services were included. TARN records were used to calculate Ws statistics in ECT and non-ECT groups to provide a measure of mortality adjusted for case mix. Glasgow Outcome Scales were contrasted to evaluate morbidity.

1724 patients in the ECT group and 3327 in the non ECT group were studied. There was an association between ECT care and improved survival. The difference in observed and expected survival was + 69 in the ECT group and − 57 in the non-ECT group. The difference between the two groups’   Ws statistic was 5.33 (95% CI 3.63 to 7.03), equivalent to one extra survivor for every 19 patients treated by an ECT group. There was no significant difference in morbidity between the two groups.

This study demonstrates a risk-adjusted significant mortality association in trauma patients, an additional 3.48 to 5.3 survivors per 100 severe (ISS ≥ 9) trauma casualties when treated by an ECT. This study details five key recommendations for future practice within HEMS. The authors encourage other ECT services to conduct further high-quality research.

Not applicable.

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