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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

Dalhousie Medicine New Brunswick, Saint John, New Brunswick, Canada.
Department of Family Medicine, Dalhousie University, Saint John Regional Hospital, Saint John, New Brunswick, Canada.
Department of Family Medicine, McGill University, Jewish General Hospital, Montreal, Quebec, Canada.
Department of Emergency Medicine, Dalhousie University, Saint John Regional Hospital, Saint John, New Brunswick, Canada.
New Brunswick Trauma Program, Saint John, New Brunswick, Canada.
Department of Emergency Medicine, Saint John Regional Hospital, Saint John, New Brunswick, Canada.
Nova Scotia Department of Health and Wellness, Trauma Nova Scotia, Halifax, Nova Scotia, Canada.
Department of Critical Care, Dalhousie University, Halifax, Nova Scotia, Canada.
Research Services, Horizon Health Network, Saint John, New Brunswick, Canada.



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.


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.


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).


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.


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

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