Abdominal haemorrhage - a preventable cause of death after field stabilization?

The causes of preventable death vary in different operational settings, and the topic has not previously been explored in a fully developed central Eu ropean rescue system. The factors associated with potentially preventable d eath were studied in a retrospective study of 430 fatal traffic accident vi ctims (1980-96) in Lorrach County, Germany. Mission protocols could be retr ieved for detailed analysis in 239 of the cases. These were studied in orde r to identify factors associated with preventable death. At the scene of th e accident, 38% of the patients died without cardiopulmonary resuscitation (CPR) and 18% after CPR. Four patients died after a certain delay without C PR before reaching hospital. A total of 43% of the victims were admitted to hospital, 5% had received prehospital CPR and the remaining 38% had not. I n a subgroup representing the experience of a single emergency physician 60 fatalities were studied. Of these, 27 (45%) patients died within the hospi tal; almost half of these cases (13/27) had been conscious at some time aft er the accident and of these, seven (7/13) died from intra-abdominal bleedi ng within 4 h after admission. The same cause of death was found in 3 of th e 14 comatose patients. Pleural drainage was carried out in four patients a nd unrecognized pneumothoraces or spinal injuries did not occur. Tracheal i ntubation was employed in 24/27. Medical antishock trousers (MAST) were not available. The data indicate that intra-abdominal haemorrhage is an undere stimated cause of death in a comprehensive rescue system, possibly as a con sequence of field stabilization. The use of MAST may be a relevant therapeu tic option to prevent these fatalities. The method offers the possibility o f intra-abdominal compression and haemostasis after tracheal intubation has been performed. Previous controlled studies on MAST may have been biased b y faulty methodology (e.g. absence of tracheal intubation) and inappropriat e indications (e.g. other causes of shock). The value of MAST in comprehens ive rescue systems should therefore be reassessed. The difficulties in iden tifying factors leading to preventable death in a retrospective analysis, a re discussed and it is recommended that a permanent prospective quality con trol be performed in all cases of fatal accidents in order to ensure the co ntinued improvement of prehospital emergency medical systems. (C) 2000 Else vier Science Ireland Ltd. All rights reserved.