PREHOSPITAL CHEST TUBES INCIDENCE AND ANALYSIS OF IATROGENIC INJURIESIN THE EMERGENCY MEDICAL-SERVICE COLOGNE

The insertion of prehospital chest tubes is still controversial. To ga in more data about the safety of this intervention we started a retros pective study: 480 patients with thoracic injuries were registered ove r a 3-year period (Emergency Medical Services Cologne); 126 of them we re intubated and 63 received chest tubes, 19 of these 63 patients died at the scene of the accident. The other 44 underwent postexaminations in order to deliver data on prehospital vital parameters, indications for invasive interventions and complications due to prehospital chest tube insertion. The patients were classified according to Champion's trauma score (TS), and it was proven that a decreased TS correlated wi th an increased number of interventions (intubation, chest tube). Thre e (= 6.8%) severe complications with organ injuries (two lungs, one li ver) and four (= 9%) minor complications (subcutaneous insertion, wron g indications) were found. None of the patients died due to these iatr ogenic injuries. In contrast to former enthusiastic reports about the safety of prehospital chest tube insertions [8], in huge EMS with many physicians, iatrogenic injuries can be expected in a range of 10%.