Injury
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Greater Sydney Area Helicopter Emergency Medical Service (GSA-HEMS) operates a doctor and paramedic team providing pre-hospital and inter-hospital retrieval. Falls are an important cause of morbidity and mortality among trauma patients. In NSW, patients injured by falling comprise 38% of those with serious to critical injuries (ISS>15). The mortality of falls in this group is 15.2%, higher than the mortality rate for other common injury mechanisms. Mortality rate for high falls (>5m) is similar to that of low/medium falls. ⋯ Our experience describes a HEMS system that is often called to falls not just based on injury severity or requirement for advanced pre-hospital intervention, but also due to geographical and topographical impediments to access and transport of the patient by ground. This may have implications in forward planning and activation of HEMS services.
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Advanced Life Support (ALS) providers may perform more invasive prehospital procedures, while Basic Life Support (BLS) providers offer stabilisation care and often "scoop and run". We hypothesised that prehospital interventions by urban ALS providers prolong prehospital time and decrease survival in penetrating trauma victims. ⋯ Prehospital resuscitative interventions by ALS units performed on penetrating trauma patients may lengthen on-scene time but do not significantly increase total prehospital time. Regardless, these interventions did not appear to benefit our rapidly transported, urban penetrating trauma patients.
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Severe bleeding after trauma frequently leads to a poor outcome. Prehospital fluid replacement therapy is regarded as an important primary treatment option. Our study aimed to assess the influence of prehospital fluid replacement therapy on the post-traumatic course of severely injured patients in a retrospective analysis of matched pairs. ⋯ Excessive prehospital fluid replacement leads to an increased mortality rate. The results of this study support the concept of restrained volume replacement in the prehospital treatment of patients with severe trauma.
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In patients with severe head injuries, transportation to a trauma centre within the "golden hour" are important markers of trauma system effectiveness but evidence regarding impacts on patient outcomes is limited. ⋯ A survival benefit exists in patients arriving earlier to hospital after severe head injury but the benefit may extend beyond the golden hour. There was evidence of improved functional outcomes in patients arriving within 60 min of injury time.
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Major haemorrhage protocols (MHP) are required as part of damage control resuscitation regimens in modern trauma care. The primary objectives of this study were to ascertain whether a MHP improved blood product administration and reduced waste compared to traditional massive transfusion protocols (MTP). ⋯ Level III diagnostic test study.