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Emerg Med J. 2018 Feb;35(2):83-88. doi: 10.1136/emermed-2016-206329. Epub 2017 Nov 4.

A traumatic tale of two cities: does EMS level of care and transportation model affect survival in patients with trauma at level 1 trauma centres in two neighbouring Canadian provinces?

Author information

1
Dalhousie Medicine New Brunswick, Saint John, New Brunswick, Canada.
2
Department of Family Medicine, Dalhousie University, Saint John Regional Hospital, Saint John, New Brunswick, Canada.
3
Department of Family Medicine, McGill University, Jewish General Hospital, Montreal, Quebec, Canada.
4
Department of Emergency Medicine, Dalhousie University, Saint John Regional Hospital, Saint John, New Brunswick, Canada.
5
New Brunswick Trauma Program, Saint John, New Brunswick, Canada.
6
Department of Emergency Medicine, Saint John Regional Hospital, Saint John, New Brunswick, Canada.
7
Nova Scotia Department of Health and Wellness, Trauma Nova Scotia, Halifax, Nova Scotia, Canada.
8
Department of Critical Care, Dalhousie University, Halifax, Nova Scotia, Canada.
9
Research Services, Horizon Health Network, Saint John, New Brunswick, Canada.

Abstract

BACKGROUND:

Two distinct Emergency Medical Services (EMS) systems exist in Atlantic Canada. Nova Scotia operates an Advanced Emergency Medical System (AEMS) and New Brunswick operates a Basic Emergency Medical System (BEMS). We sought to determine if survival rates differed between the two systems.

METHODS:

This study examined patients with trauma who were transported directly to a level 1 trauma centre in New Brunswick or Nova Scotia between 1 April 2011 and 31 March 2013. Data were extracted from the respective provincial trauma registries; the lowest common Injury Severity Score (ISS) collected by both registries was ISS≥13. Survival to hospital and survival to discharge or 30 days were the primary endpoints. A separate analysis was performed on severely injured patients. Hypothesis testing was conducted using Fisher's exact test and the Student's t-test.

RESULTS:

101 cases met inclusion criteria in New Brunswick and were compared with 251 cases in Nova Scotia. Overall mortality was low with 93% of patients surviving to hospital and 80% of patients surviving to discharge or 30 days. There was no difference in survival to hospital between the AEMS (232/251, 92%) and BEMS (97/101, 96%; OR 1.98, 95% CI 0.66 to 5.99; p=0.34) groups. Furthermore, when comparing patients with more severe injuries (ISS>24) there was no significant difference in survival (71/80, 89% vs 31/33, 94%; OR 1.96, 95% CI 0.40 to 9.63; p=0.50).

CONCLUSION:

Overall survival to hospital was the same between advanced and basic Canadian EMS systems. As numbers included are low, individual case benefit cannot be excluded.

KEYWORDS:

emergency care systems, advanced practitioner; emergency care systems, primary care; prehospital care; trauma

PMID:
29102923
DOI:
10.1136/emermed-2016-206329
[Indexed for MEDLINE]

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