Efficacy of prehospital critical care teams for severe blunt head injury in the Australian setting

Objective: To determine whether prehospital critical care teams (CCT) would result in improved functional outcomes for road trauma related severe head injury in the Australian setting, when compared with standard advanced lif e support measures provided by paramedics. Methods: Retrospective review of 250 patients treated by paramedics and 46 patients treated by CCT transported directly from the accident scene, with a prehospital Glasgow coma scale (GCS) less than or equal to 8. Results: CCT-treated patients had longer median prehospital times (113 vers us 45 min, P < 0.001), and a higher prehospital intubation rate (100% versu s 36%, P < 0.001) than paramedic-treated patients. On multivariate analysis , revised trauma score greater than or equal to 4.45 (odds ratio [OR] 2.31, 95% Cl: 1.15-4.65), lower injury severity score (OR 1.04, 95% Cl: 1.02-1.0 6), age less than or equal to 25 years (OR 1.76, 95% Cl: 1.13-2.75), absenc e of an acute subdural haematoma (OR 3.36, 95% Cl: 1.89-5.95) and prehospit al treatment by a CCT (OR 2.70, 95% CI: 1.48-4.95) independently predicted better outcome. Conclusion: The range of advanced interventions provided by the CCT were as sociated with improved functional outcome. Further studies are required to determine the individual factors responsible. (C) 2001 Elsevier Science Ltd . All rights reserved.