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

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.

doi:10.1016/j.injury.2007.04.008

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Volume 38, Issue 9 , Pages 1001-1013, September 2007

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

Bahman S. Roudsari
- Department of Epidemiology, University of Texas, School of Public Health, USA
- Corresponding author. Tel.: +1 214 648 1054; fax: +1 214 648 1081.
Avery B. Nathens
- St. Michael's Hospital, Toronto, Canada
Carlos Arreola-Risa
- Secretaría de Salud, Sistema Estatal de Atención de Emergencias Médicas, Monterrey, Nuevo León, Mexico
Peter Cameron
- Department Epidemiology and Preventive Medicine, Monash School of Public Health, Alfred Hospital, Australia
Ian Civil
- University of Auckland, Auckland Hospital, Auckland, New Zealand
Giouli Grigoriou
- Center for Research and Prevention of Injuries, Medical School, University of Athens, Athens, Greece
Russel L. Gruen
- Department of Health Services Research and Policy, Menzies School of Health Research, Australia
Thomas D. Koepsell
- Harborview Injury Prevention and Research Center, Department of Epidemiology, University of Washington, Seattle, USA
- Harborview Injury Prevention and Research Center, Department of Health Services, University of Washington, Seattle, USA
Fiona E. Lecky
- University of Manchester, Department of Emergency Medicine, Manchester, United kingdom
Rolf L. Lefering
- Biochemical & Experimental Division, University of Cologne, Cologne, Germany
Moishe Liberman
- Montreal General Hospital, McGill University Health Center, Divisions of Surgery and Clinical Epidemiology, Montreal, Canada
Charles N. Mock
- Harborview Injury Prevention and Research Center, Department of Surgery, University of Washington, Seattle, USA
- Harborview Injury Prevention and Research Center, Department of Epidemiology, University of Washington, Seattle, USA
Hans-Jörg Oestern
- Chefarzt der Klinik für, Unfall und Wiederherstellungschirurgie, Allgemeines Krankenhaus Celle, Germany
Elenie Petridou
- Department of Hygiene and Epidemiology, Athens University Medical School, Athens, Greece
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
Thomas A. Schildhauer
- Chirurgische Klinik und Poliklinik, BG Kliniken Bergmannsheil, Ruhr-Universitat Bochum, Bochum, Germany
Christian Waydhas
- Klinik und Poliklinik für Unfallchirurgie, Universitätsklinikum Essen, Hufelandstr. Germany
Moosa Zargar
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
Frederick P. Rivara
- Harborview Injury Prevention and Research Center, Department of Pediatrics, University of Washington, Seattle, USA
- Harborview Injury Prevention and Research Center, Department of Epidemiology, University of Washington, Seattle, USA

Accepted 10 April 2007.

Summary

Objectives

To compare patient- and injury-related characteristics of trauma victims and pre-hospital trauma care systems among different developed and developing countries.

Method

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.

Results

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 10.1min) and Montreal, Canada (median 16.1min) reported the shortest and Germany (median: 30min) and Austria (median: 26min) 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).

Conclusion

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.

Keywords: Pre-hospital trauma care, Emergency Medical Service (EMS) systems, Developed and developing countries, Advanced Life Support, Basic Life Support, Intravenous fluid therapy, Endotracheal intubation