Prehospital emergency life-saving technicians promote the survival of trauma patients: A retrospective cohort study

Appropriate decisions by medical technicians at a trauma scene may influence a patient's prognosis. Emergency life-saving technicians (ELSTs) are certified specialists trained with the knowledge to provide advanced techniques for prehospital emergency care in Japan. However, the benefit of trea...

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Bibliographic Details
Published in:The American journal of emergency medicine 2022-06, Vol.56, p.218-222
Main Authors: Nishimura, Takeshi, Nojima, Tsuyoshi, Naito, Hiromichi, Ishihara, Satoshi, Nakayama, Shinichi, Nakao, Atsunori
Format: Article
Language:English
Subjects:
Adolescent
Aged
Blood transfusion
Blood transfusions
Cohort analysis
Embolization
Emergency life-saving technician
Emergency medical care
Emergency Medical Services
Health services
Hospitals
Humans
Injury Severity Score
JTDB
Lifesaving
Medical prognosis
Odds Ratio
Ostomy
Patients
Prehospital
Prognosis
Radiology
Regression analysis
Retrospective Studies
Survival
Technicians
Transfusion
Trauma
Trauma care
Trauma Centers
Variables
Wounds and Injuries - therapy
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Summary:Appropriate decisions by medical technicians at a trauma scene may influence a patient's prognosis. Emergency life-saving technicians (ELSTs) are certified specialists trained with the knowledge to provide advanced techniques for prehospital emergency care in Japan. However, the benefit of treatment by ELSTs compared to basic emergency medical technicians (BEMTs) remains unclear. The aim of this study is to determine whether treatment by ELSTs improves outcomes for trauma patients. We retrospectively reviewed the Japan Trauma Data Bank for the years 2004 to 2017. Patients transferred to the hospital directly from the trauma scene and at least 16 years old were included in this study. The following criteria were used to exclude patients; presence of burns, untreatable severe traumas, unknown ELST attendance, and missing prognosis. We compared two groups (ELST group: patients transported by emergency medical services (EMS) with the presence of at least one ELST; BEMT group: patients transported only by BEMTs). Primary outcome was survival to discharge. Secondary outcomes were the need of definitive treatments defined by surgical intervention, intravascular radiology and blood transfusion at the receiving hospital within 24 h. A multivariable logistic regression model was used to calculate odds ratio (OR) and confidence intervals (CI) adjusted by age, sex, revised trauma score, and Injury severity score (ISS). Overall survival to discharge did not improve significantly (adjusted OR 1.13, 95% CI 0.99–1.30) with ELST intervention. In-hospital blood transfusion was more frequently required in the ELST group (adjusted OR 1.10, 95% CI 1.01–1.20). Emergency interventions (adjusted OR 1.03, 95% CI 0.97–1.09) were not different between the groups. In stratified analysis, the benefit of ELST attendance for survival was observed among patients with ISS
ISSN:0735-6757
1532-8171
DOI:10.1016/j.ajem.2022.04.004