The key to survival after trauma
Air ambulance critical in getting patients to best help, study finds
Some severely injured patients are not being treated at trauma centres because Toronto Emergency Medical Services workers are unable to recognize when it is best for them to receive specialized care, according to a top emergency physician.
And across Ontario, patients are not being taken quickly enough — or not at all — to trauma centres because of problems with patient transport systems, including the troubled air ambulance service ORNGE.
A study investigating survival rates of car crash victims in Ontario found that fewer than half of those with serious injuries are taken directly to trauma centres, putting lives at risk.
The research also found that the chance of surviving at least 48 hours increases by more than 30 per cent if they’re transported di- rectly to such specialized centres rather than to the closest hospital.
Dr. Avery Nathens, trauma director at St. Michael’s Hospital and the study’s lead author, said the research provides yet more evidence that a “highly functioning air ambulance is critical” in Ontario.
“It speaks to the need to develop adequate systems to ensure that patients who meet certain criteria are brought to the right place as quickly as possible,” he said
The study also highlights the need to better educate land ambulance personnel about who would benefit from trauma care. In Toronto, “there is a problem with them recognizing a severely injured patient,” Nathens said.
Trauma centres are staffed 24 hours a day with specially trained doctors and nurses who can provide immediate treatment for people with severe injuries suffered, for example, in car accidents, falls or shootings.
Ontario has nine adult trauma centres, including St. Michael’s Hospital and Sunnybrook Health Sciences Centre in Toronto.
The study, published in the June issue of the Journal of Trauma and Acute Care Surgery, examined data from car accidents in Ontario between 2002 and 2010. Of the 6,341 occupants with severe injuries, 45 per cent were taken directly to a trauma centre. Of the 3,484 victims taken to the nearest hospital, just 57 per cent were ultimately transported to a trauma centre. An analysis found that patients taken right to a trauma centre were at least 30 per cent more likely to survive the first 48 hours after the car crash. “We found a large number of patients are first transported to a non-trauma centre, and we know from other studies that that dramatically delays the time to definitive care, sometimes in the range of three, four or even six hours longer,” Nathens said. “For trauma patients, we always talk about the golden hour. If you can get to patients as early as possible and provide them with the care they need, mortality is lower.”
EMS workers use a set of criteria to determine whether a patient requires specialized treatment. Guidelines suggest victims be taken to a trauma centre if the ambulance is within a 30-minute drive.
If a trauma centre is farther away, Nathens said EMS personnel must choose whether to call for air transport or go to the nearest hospital.
In the Toronto area, some EMS personnel are not making the appropriate calls, he said.
On Friday, a spokesperson for Toronto EMS said the agency had not had time yet to review the study and couldn’t comment.
In an emailed statement, Ron McKerlie, interim president and CEO of ORNGE, said Ontario has a well-developed provincial trauma system with well established protocols and criteria to treat patients.
“What the article correctly points out, is that there is room for improvement in getting the appropriate patients to the trauma centres as quickly as possible,” he said.