The Frequency and Success Rate of Procedures Performed on Trauma Patients in the Prehospital Setting

Introduction—Prehospital providers respond regularly to victims of trauma, administering care and treatment. Treatment and performed procedures vary geographically due to changes in protocol and differing transport times. Not all procedures are performed frequently, and success rates may vary.

Objective—To perform a statewide, population-based retrospective study to determine the frequency and success rate of procedures performed on trauma patients in the prehospital setting.

Methods—A retrospective observational study of prehospital procedure frequency and success rate using the North Carolina Prehospital Care Reporting System (PREMIS) data from July 1, 2012 to December 31, 2012. All patients were included in the study. The procedures of interest included Combitubes, King Airways, LMA, nasotracheal intubation (NTI), endotracheal intubation (ETI), rapid sequence induction (RSI), needle cricothyrotomy, surgical cricothyrotomy, decompression, peripheral venous access (IV), external jugular access (EJ), femoral access, adult and pediatric intraosseous (IO) access, pleural decompression, MAST application, spinal immobilization, basic splinting, traction and hemostatic wound care.

Results—A total of 115,764 patients were included in the study. Of these, 47.8% were male, 64.5% were Caucasian, 42.3% suffered blunt trauma, and the average age was 48 years. Airway procedure attempts and success rates were as follows: Combitube (13, 76.9%), King Airways (153, 88.9%), LMA (22, 100%), NTI (16, 50%), ETI (480, 72.9%), RSI (167, 89.2%), needle cricothyrotomy (9, 88.9%) and surgical cricothyrotomy (5, 100%). Vascular access attempts and success rates were as follows: IV (37,708, 88.8%), EJ (25, 76%), femoral access (132, 98.4%), adult IO (280, 91.8%) and pediatric IO (169, 93.5%). Additional procedures were examined for performance frequency and included pleural decompression (102), MAST application (424), spinal immobilization (32,717), basic splinting (4,770), traction splint (173) and hemostatic wound care (90).

Conclusion—Prehospital procedures vary greatly in the frequency with which they are performed and their associated success rates. Additional research is needed to determine the impact continuing education may have on frequency and success rates of procedures performed in the prehospital setting.