Physician Prehospital Care in Mexico City: Retrospective Analysis of Endotracheal Intubation in Patients with Severe Head Trauma

Abstract

Introduction:In Mexico, physicians have become part of public service prehospital care. Head injured patients are a sensitive group that can benefit from early advanced measures to protect the airway, with the objective to reduce hypoxia and maintain normocapnia.Problem:The occurrence of endotracheal intubation to patients with severe head injuries by prehospital physicians working at Mexico City’s Service of Emergency Medical Care (SAMU) is unknown.Methods:A retrospective analysis of five-year data (2012-2016) from Mexico City’s Medical Emergencies Regulation Center was performed. Only SAMU ambulance services were analyzed. Adult patients with a prehospital diagnosis of head injury based on mechanism of injury and physical examination with a Glasgow Coma Scale (GCS) <nine were included.Results:A total of 293 cases met the inclusion criteria; the mean GCS was five points. Of those, 150 (51.1%) patients were intubated. There was no difference in the occurrence of intubation among the different GCS scales, or if the patient was considered to have isolated head trauma versus polytrauma. Fifteen patients were intubated using sedation and neuromuscular blockage. Four patients were intubated with sedation alone and six patients with neuromuscular blockage alone. One patient was intubated using opioid analgesia, sedation, and neuromuscular blockage.Conclusions:Patients with severe head injuries cared by prehospital physicians in Mexico City were intubated 51.1% of the time and were more likely to be intubated without the assistance of anesthetics.

Injury-Related Emergency Medical Service Calls, Traffic Accidents, and Crime in Mexico City Before and During the COVID-19 Pandemic

“…A few studies have been published that examine the prehospital care system in Mexico City. [20][21][22] Even fewer studies have been published that examine the prehospital care system using borough-level analyses of Mexico City. 23 In this study, the results at the state-level and borough-levels show similar trends for injury-related 9-1-1 calls, crime, and traffic accidents, although there is some variation in the rate of decline by borough, especially at the time of the first wave of public health orders in March 2020.…”