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Team 5 Investigates Uncovers Critical Care Breakdown in Trauma Response: Life Saving Tools Unused, Trauma Care Guidelines Ignored
BOSTON—Team 5 Investigates uncovered a breakdown in the state's emergency medical system that could be putting all of us at risk. NewsCenter 5's Sean Kelly reported on Thursday that life-saving tools for patients with life-threatening injuries are not always used, and the majority of EMS directors are unaware of it. [read more]
This report was based on the work by HSRI researchers Nick Mango and Liz Garthe, and has important statewide, as well as national, implications.
Most Serious Crash Victims not Receiving Life-Saving Resources
After a serious car crash where your survival depends on urgent helicopter transport to a specialized trauma center—will you receive it? Most likely not, according to the findings of a first-in-the-nation study by Health and Safety Research, Inc., a Massachusetts based non-profit. Your chance of survival can be reduced by 2 to 10 times as a result.
The findings are particularly striking because for the study year Massachusetts had the lowest crash death rate in the U.S., and one of the 10 lowest in the world. This suggests that other states and countries may under-utilize life-saving resources at higher rates than shown in this study.
The HSRI comprehensive one-year statewide study of the response of Massachusetts' EMS and hospital system to people involved in fatal level car crashes appears in the February 2007 Journal of Trauma, a leading peer-reviewed medical journal. The study was conducted under the auspices of the Massachusetts Department of Public Health and the Massachusetts Governor's Highway Safety Bureau.
A sophisticated methodology tracked the path and outcome of every involved person, whether transported or not, starting at the crash scene, including helicopter and ground ambulance use, community or specialized trauma center hospital treatment, and inter-hospital transfers. Qualification for helicopter transport and/or trauma center care was calculated using state/national guidelines. The study considered age, sex, pre-existing conditions, complications, overall injury severity, geographic location and distances from the crash scene to treatment locations.
Among other major findings, the HSRI study shows that 83% of people who qualified for direct helicopter transport to a trauma center did not receive it. Sixty-two percent of people who qualified for direct transport (by helicopter or ground) to a trauma center did not receive it. Helicopters did not arrive at 88% of the crashes, primarily because they were never requested. Survival varied by a factor of 3 between the state's five EMS regions, and up to a factor of 10 times, depending where and how people were taken for treatment. The people who qualified and received transport directly to a trauma center overall had about twice the survival of those who qualified but did not receive those resources.
"Advanced transport and hospital resources can't be effective when victims are not directed to them," says Nicholas Mango, lead author of the study. "Our findings show that the majority of severely injured persons did not receive the advanced medical resources they qualified for. Had they received those services, we believe crash fatalities could be substantially reduced."
Full results are reported in Mango N, Garthe E.: Statewide tracking of crash victims' medical system utilization and outcomes. J Trauma. 2007 Feb;62(2):436-60. PMID: 17297336 [PubMed–in process, see abstract]
Copyright © 2007, 2008 Health and Safety Research, Inc.
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