Study On The Epidemiological Characteristics And Emergency Medical Services Outcome Of Prehospital Trauma Patients In Shenzhen

Objectives 1.To analyze the epidemiological features of prehospital trauma patients in Shenzhen in order to provide evidence for scientific policy making of trauma prevention and control.2.To explore risk factors in the effectiveness of prehospital care on severe traffic injuries.3.To examine the problems during prehospital care,emergency department services,and in-hospital services of trauma deceases patients on the basis of a comprehensive approach in order to provide evidence for improving trauma care system and process.Methods 1.The“120”dispatch data and prehospital records from 2011 to 2015 in Shenzhen were sorted out and introduced to SPSS 19.0.Descriptive analyses were then performed.2.The“120" dispatch data and prehospital records from 2011 to 2015 in Shenzhen were sorted out.The possible factors likely related to the effectiveness of prehospital care were taken into account so as to find the risk factors through univariate and multivariate stepwise logistic regression analyses.3.The data related to trauma patients who died in the first three days during the emergency medical services were collected and sorted out through an investigation on emergency deceased cases in Shenzhen in 2014.A comprehensive analyzing approach including longitudinal comparison with the data in 2004,preventable death analysis through multivariate logistic regression analyses,export panel review were adopted so as to explore the main problems existing in prehospital,emergency department,and in-hospital services.Results 1.Trauma patients increase every year from 2011 to 2015.Among the 79480 cases of trauma patients enrolled,the young and middle-age population aging from 20 to 49 accounts for 76.5%.Trauma cases occurred the most in the last season and the least in Feb.In the 24-hour distribution,trauma cases occurred the most from 20 to 22pm and the least from 4 to 6 am.Pre-hospital response time distribution was non-normal distribution.The median of time from call to ambulance arrival and from call to hospital arrival was 9.12 and 23.31 minutes,respectively.The response time distribution among every administrative district was un-balanced.The three top causes of trauma were traffic injuries,fight injuries,and fall injuries,in which traffic injuries accounted 42.74%.The top causes before 55 years old were traffic injuries,fight injuries and fall injuries,while those after 56 years old were fall injuries,traffic injururies and fight injuries,respectively,in which fall injuries accounted for 39.51%.The percentage of lower-limb injuries and spine injuries increased with age.The top 5 causes of severe trauma cases were traffic injuries,high fall injuries,knife-cut injuries,fight injuries and alcoholism injuries,respectively.2.A total of 488 casualties were enrolled in this study.Among them,prehospital measures on 347 casualties were ineffective and the ineffectiveness rate was 71.1%.The following factors have statistical significance after univariate analyses:sex,age,injured body parts,coma,PHI,response time and prehospital measures.After multivariate analyses,5 factors were identified as risk factors as follow:injured body parts,coma,PHI,response time and prehospital measures.3.The prehospital deaths of trauma patients in 2014 accounted for 73.44%,the deaths on arrival accounted for 92.71%;among the deceased cases in the emergency department(ED),consultation within 30 minutes accounted for 58.62%;among the deceased hospitalised patents,consultation within 30 minutes,blood transfusion,and operation within 30 minutes decreased to under 30%,compared to those indicators in 2004.The preventable death rate was 27.7%,and its associated influencing factors included place of injury,mechanism of injury,inter-hospital transfer,place of death,and cause of death,excluding the hospital level.Among the expert reviews,the occurrence of problems in the ED was the highest,accounting for 50.37%and they are mainly process related problems which accounted for 95.59%;the occurrence of system problems in the hospitalized cases was the highest,accounting for 50%.Conclusions 1.There are three main epidemiological features in prehospital trauma patents in Shenzhen.First,the epidemiology is greatly associated with the migration nature of Shenzhen city.Second,the emergency medical resources in Shenzhen are still unbalanced.Third,the elderly trauma patients have their own distribution feature,which deserves particular concerns.2.Injured parts,coma and PHI are important factors on the effectiveness of prehospital care,and shortening response time and professionalizing prehospital care can improve the effectiveness of prehospital care and therefore the prognosis of severe trauma patients.3.Self and mutual rescuing should be stressed in the light of high percentage of prehospital deaths and deaths on ambulance arrival.The preventable death rate is higher than that in the developed countries mainly because the "green track" of the EMSS has not yet been really implemented and the practice of EMSS lacks of standarization.In general,the trauma care system in Shenzhen needs to be redesigned.