Outcomes of Emergency Medical Service Usage in Severe Road Traffic Injury during Thai Holidays

Abstract

IntroductionThailand has the highest mortality from road traffic injury (RTI) in the world. There are usually higher incident rates of RTI in Thailand over long holidays such as New Year and Songkran. To our knowledge, there have been no studies that describe the impact of emergency medical service (EMS) utilization by RTI patients in Thailand. We sought to determine the outcomes of EMS utilization in severe RTIs during the holidays.MethodsWe conducted a retrospective review study by using a nationwide registry that collected RTI data from all hospitals in Thailand during the New Year holidays in 2008–2015 and Songkran holidays in 2008–2014. A severe RTI patient was defined as one who was admitted, transferred to another hospital, or who died at the emergency department (ED) or during referral. We excluded patients who died at the scene, those who were not transported to the ED, and those who were discharged from the ED. Outcomes associated with EMS utilization were identified by using multiple logistic regression and adjusted by using factors related to injury severity.ResultsOverall we included 100,905 patients in the final analysis; 39,761 severe RTI patients (39.40%; 95% confidence interval [CI] 95% CI [39.10%–39.71%]) used EMS transportation to hospitals. Severe RTI patients transported by EMS had a significantly higher mortality rate in the ED and during referral than that those who were not (2.00% vs. 0.78%, p < 0.001). Moreover, EMS use was significantly associated with increased mortality rate in the first 24 hours of admission to hospitals (1.38% for EMS use vs. 0.57% for no EMS use, p < 0.001). EMS utilization was a significant predictor of mortality in EDs and during referral (adjusted odds ratio [OR] 2.19; 95% CI [1.88–2.55]), and mortality in the first 24 hours of admission (adjusted OR 2.31; 95% CI [1.95–2.73]).ConclusionIn this cohort, severe RTI patients transported by EMS had a significantly higher mortality rate than those who went to hospitals using private vehicles during these holidays.

Modelling Road Accident Fatalities with Underdispersion and Zero-inflated Counts

“…For decades, the government has put a lot of time, budget and effort into road safety campaigns to raise awareness and change attitude and behavior, especially during festivals. But so far, all earlier campaigns have shown no reductions [9,[11][12][13]. A new insight from our study showed that the number of deaths was not quite different between the months but the number of nonfatal accidents.…”

Asociación entre tiempo de atención pre hospitalaria y la mortalidad hospitalaria en víctimas de accidentes de tránsito

“…En el estudio de casos y controles de Vera-Lopez et al (14) se encontró que no había asociación significativa entre el tiempo de atención pre hospitalaria con la mortalidad (OR 0,99; IC95% 0,97-1,01; P=0,318) sin embargo se encontró una gran asociación significativa a la mortalidad a aquellos pacientes que requirieron atención médica pre hospitalaria (OR 28,30; IC95% 3,60-222,58; P= 0,001), como en el caso del estudio de Boniface et al (17) y el de Riyapan et al (12) donde la utilización del servicio médico de emergencia como medio de transporte pre hospitalario en AT estuvo asociado 2,19 veces más a la mortalidad en emergencia y en la derivación (OR ajustado 2,19; IC 95% [1,88-2,55]), así mismo aumento significativamente la mortalidad en las primeras 24 horas después del ingreso al servicio de emergencia (OR ajustado 2,31; IC 95% [1,95-2,73]). Así mismo se halló que la tasa de mortalidad en los departamentos de emergencias y durante la derivación en pacientes con lesiones graves por AT que requirieron ser transportados por el servicio médico de emergencia fue significativamente mayor que en aquellos que no lo fueron (2,00% vs. 0,78%; p <0,001).…”

Mapping global evidence on strategies and interventions in neurotrauma and road traffic collisions prevention: a scoping review

“…Organised trauma systems were explored in four papers, 2 from HICs and 2 from LMICs. The LMIC systems focussed on life support (Basic Life Support by first responders and Advanced Life Support by paramedics), whereas the HIC systems included triage, transport and a multidisciplinary pre-hospital management of patients [68][69][70][71].…”