PREVENTABLE DEATH EVALUATION OF THE APPROPRIATENESS OF THE ON-SITE TRAUMA CARE PROVIDED BY URGENCES-SANTE PHYSICIANS

The study is based on 44 preventable deaths occurring in a cohort of 3 60 patients with major trauma, These cases were reviewed by a committe e of nine experts, The mean Injury Severity Score (ISS) was 28, and mo st cases had injuries to the head/neck (68%) and chest (64%), The mean (+/- SD) observed prehospital times, and those considered the maximum allowable by the committee, were 40.6 +/- 12.0 minutes for head/neck injuries and 23.9 +/- 12.2 minutes for chest injuries (p < 0.05), Intr avenous (IV) lines were started in 38 (86%) of the patients, The commi ttee classified this procedure as harmful for 16 (42%) and neutral for 19 (50%), Among the 18 (46%) that were intubated, this intervention w as considered harmful for 17% and neutral for 39%, In two of the three patients for whom a pneumatic antishock garment was applied, this pro cedure was considered harmful, Of the 34 patients that required direct transport at a level I trauma center, 50% were transferred to such a hospital, These results show significant prehospital delays and high r ates of inappropriate TV line initiation and intubation in trauma pati ents receiving on-site care by physicians, We conclude that prehospita l care protocols for trauma patients should emphasize prompt transport and specific on-site care algorithms.