(A153) Does Prehospital Delay Change Trauma Outcomes in Mumbai?

Abstract

Introduction

Prehospital delay in trauma victims has been associated with worsened trauma outcomes, and forms the basis of emergency medical services (EMS). Survival rates of severely injured patients with life and limb threatening trauma were studied and corrlated with prehospital delays in Mumbai, India, where there is no central EMS system.

Methods

From October 2010 to March 2011, a researcher collected Injury Severity Score and prehospital time delay data in all severely injured patients arriving at the Trauma Centre. The time of injury, and time and mode of transport to the Trauma Centre were recorded, along with the details of the injury and the physiological parameters upon admission. Information regarding time and place of the crash, arrival to a trauma care facility, injuries, and survival were noted.

Results

A taxicab was the most common mode of transport followed by a police van, private ambulances, and government ambulances. Patients reached the Trauma Centre more quickly when accompanied by relatives or police, and took longer if they were examined at peripheral centers, were unknown victims, or arrived by Government ambulances. Better outcomes were observed in patients with informal carers. The majority of the victims presented within three hours of trauma.

Conclusions

Prehospital delay did not correlate well with poorer outcomes. Further research is needed to determine how many injured die on the way to the hospital in countries without a formal EMS system. Implementation of a high-cost, state-funded EMS system in a congested, resource-poor, urban setting must be balanced with the insufficient evidence about whether prehospital field interventions actually improve survival outcomes.