• Amir Norouzpour, Ali Reza Khoshdel, Mohammad-Hadi Modaghegh, and Gholam-Hossein Kazemzadeh.
• Department of Epidemiology, Faculty of Medicine, AJA University of Medical Sciences, Tehran, IR Iran ; Vascular and Endovascular Surgery Research Center, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, IR Iran.
• Trauma Mon. 2013 Sep 1;18(2):62-6.

BackgroundPrehospital management of gunshot-wounded (GW) patients influences injury-induced morbidity and mortality.ObjectivesTo evaluate prehospital management to GW patients emphasizing the protocol of patient transfer to appropriate centers.Patients And MethodsThis prospective study, included all GW patients referred to four major, level-I hospitals in Mashhad, Iran. We evaluated demographic data, triage, transport vehicles of patients, hospitalization time and the outcome.ResultsThere were 66 GW patients. The most affected body parts were extremities (60.6%, n = 40); 59% of cases (n = 39) were transferred to the hospitals with vehicles other than an ambulance. Furthermore, 77.3% of patients came to the hospitals directly from the site of event, and 22.7% of patients were referred from other medical centers. EMS action intervals from dispatchers to scene departure was not significantly different from established standards; however, arrival to hospital took longer than optimal standards. Additionally, time spent at emergency wards to stabilize vital signs was significantly less in patients who were transported by EMS ambulances (P = 0.01), but not with private ambulances (P = 0.47). However, ambulance pre-hospital care was not associated with a shorter hospital stay. Injury Severity was the only determinant of hospital stay duration (β = 0.36, P = 0.01) in multivariate analysis.ConclusionsGW was more frequent in extremities and the most patients were directly transferred from the accident site. EMS (but not private) ambulance transport improved patients' emergency care and standard time intervals were achieved by EMS; however more than a half of the cases were transferred by vehicles other than an ambulance. Nevertheless, ambulance transportation (either by EMS or by private ambulance) was not associated with a shorter hospital stay. This showed that upgrade of ambulance equipment and training of private ambulance personnel may be needed.

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