A traumatic tale of two cities: does EMS level of care and transportation model affect survival in patients with trauma at level 1 trauma centres in two neighbouring Canadian provinces?

Abstract

background Two distinct Emergency Medical Services (EMS) systems exist in Atlantic Canada. Nova Scotia operates an Advanced Emergency Medical System (AEMS) and New Brunswick operates a Basic Emergency Medical System (BEMS). We sought to determine if survival rates differed between the two systems. Methods This study examined patients with trauma who were transported directly to a level 1 trauma centre in New Brunswick or Nova Scotia between 1 April 2011 and 31 March 2013. Data were extracted from the respective provincial trauma registries; the lowest common Injury Severity Score (ISS) collected by both registries was ISS≥13. Survival to hospital and survival to discharge or 30 days were the primary endpoints. A separate analysis was performed on severely injured patients. Hypothesis testing was conducted using Fisher's exact test and the Student's t-test. results 101 cases met inclusion criteria in New Brunswick and were compared with 251 cases in Nova Scotia. Overall mortality was low with 93% of patients surviving to hospital and 80% of patients surviving to discharge or 30 days. There was no difference in survival to hospital between the AEMS (232/251, 92%) and BEMS (97/101, 96%; OR 1.98, 95% CI 0.66 to 5.99; p=0.34) groups. Furthermore, when comparing patients with more severe injuries (ISS>24) there was no significant difference in survival (71/80, 89% vs 31/33, 94%; OR 1.96, 95% CI 0.40 to 9.63; p=0.50). Conclusion Overall survival to hospital was the same between advanced and basic Canadian EMS systems. As numbers included are low, individual case benefit cannot be excluded.

Development of a national out-of-hospital transfusion protocol: a modified RAND Delphi study

“…Most Canadian local and regional emergency medical services ground ambulances will probably not be dispatched to sufficient numbers of critically ill patients to warrant the addition of OHT to such services. 17 However, some emergency medical services might create smaller units for second-tier dispatch to selected patient groups (for example, major trauma), and such units should be considered CCTOs in the context of this document. 1 1.2 The protocol shall be developed by a multidisciplinary team, be approved by the participating transfusion service, and comply with best practices and local and national transfusion guidelines.…”

Comparison of clinical and anatomical criteria for resuscitative endovascular balloon occlusion of the aorta (REBOA) among major trauma patients in Nova Scotia

“…The rate of penetrating trauma is around 10%, with approximately 400-450 adult trauma team activations annually, based on physiologic, anatomic, mechanistic, and logistic criteria [15]. Major trauma patients transported direct from scene to the QEII HSC have a median prehospital time of 51 min (interquartile range 37.0-71.3 min) [16]. There is currently no REBOA program at our centre.…”