Emergency Medical Service (EMS) systems in developed and developing countries

• Published in: Injury Vol. 38; no. 9; pp. 1001 - 1013
• Main Authors: Roudsari, Bahman S., Nathens, Avery B., Arreola-Risa, Carlos, Cameron, Peter, Civil, Ian, Grigoriou, Giouli, Gruen, Russel L., Koepsell, Thomas D., Lecky, Fiona E., Lefering, Rolf L., Liberman, Moishe, Mock, Charles N., Oestern, Hans-Jörg, Petridou, Elenie, Schildhauer, Thomas A., Waydhas, Christian, Zargar, Moosa, Rivara, Frederick P.
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier Ltd 01.09.2007; Elsevier
• Subjects: Adolescent; Adult; Advanced Life Support; Aged; Aged, 80 and over; Basic Life Support; Biological and medical sciences; Cross-Cultural Comparison; Delivery of Health Care - standards; Developed and developing countries; Developed Countries; Developing Countries; Emergency Medical Service (EMS) systems; Emergency Medical Services - methods; Emergency Medical Services - standards; Emergency Service, Hospital - standards; Endotracheal intubation; Female; Humans; Injuries of the limb. Injuries of the spine; Intravenous fluid therapy; Life Support Care - methods; Life Support Care - standards; Male; Medical sciences; Middle Aged; Orthopedics; Pre-hospital trauma care; Quality of Health Care - standards; Transportation of Patients - methods; Trauma Centers - standards; Trauma Severity Indices; Traumas. Diseases due to physical agents; Emergency Medical Service (EMS) systems; Intravenous fluid therapy; Developed and developing countries; Pre-hospital trauma care; Endotracheal intubation; Advanced Life Support; Basic Life Support; Performance evaluation; Human; Intravenous administration; Developing countries; Trauma; Care; Treatment; Hospital; Intubation; Emergency; Trachea
• ISSN: 0020-1383; 1879-0267
• DOI: 10.1016/j.injury.2007.04.008

To compare patient- and injury-related characteristics of trauma victims and pre-hospital trauma care systems among different developed and developing countries. We collated de-identified patient-level data from national or local trauma registries in Australia, Austria, Canada, Greece, Germany, Iran, Mexico, New Zealand, the Netherlands, the United Kingdom and the United States. Patient and injury-related characteristics of trauma victims with injury severity score (ISS) >15 and the pre-hospital trauma care provided to these patients were compared among different countries. A total of 30,339 subjects from one or several regions in 11 countries were included in this analysis. Austria (51%), Germany (41%) and Australia (30%) reported the highest proportion of air ambulance use. Monterrey, Mexico (median 10.1 min) and Montreal, Canada (median 16.1 min) reported the shortest and Germany (median: 30 min) and Austria (median: 26 min) reported the longest scene time. Use of intravenous fluid therapy among advanced EMS systems without physicians as pre-hospital care providers, varied from 30% (in the Netherlands) to 55% (in the US). The corresponding percentages in advanced EMS systems with physicians actively involved in pre-hospital trauma care, excluding Montreal in Canada, ranged from 63% (in London, in the UK) to 75% in Germany and Austria. Austria and Germany also reported the highest percentage of pre-hospital intubation (61% and 56%, respectively). This study provides an early look at international variability in patient mix, process of care, and performance of different pre-hospital trauma care systems worldwide. International efforts should be devoted to developing a minimum standard data set for trauma patients.