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      Pre-Hospital Trauma Care in Road Traffic Accidents in Kashan, Iran

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          Abstract

          Background

          Iran has one of the highest rates of road traffic accidents (RTAs) worldwide. Pre-hospital trauma care can help minimize many instances of traffic-related mortality and morbidity.

          Objectives

          The aim of this study was to assess the characteristics of pre-hospital care in patients who were injured in RTAs, admitted to hospital. The focus was mainly directed at evaluating pre-hospital trauma care provided in city streets and roads out of the city.

          Patients and Methods

          This retrospective study was carried out on all trauma patients, transported by the emergency medical service (EMS) system, who were admitted to Kashan Shahid-Beheshti hospital during the period from March 2011 to March 2012. The patients’ demographic data, location of accident, damaged organs, mechanism of injury, injury severity, pre-hospital times (response, scene, transport), pre-hospital interventions and outcomes, were extracted from the data registry and analyzed through descriptive statistics using SPSS 18 software.

          Results

          Findings of this study showed that, 75% of RTAs occurred on city streets (n = 1 251). Motor-car accidents were the most frequent mechanism of RTA on city streets (n = 525) (42%), while car rollover was the most frequent mechanism of RTA on roads out of the city (n = 155) (44.4%). The mean pre-hospital time intervals (min); response, scene, and transport for all patients were 6.6 ± 3.1, 10.7 ± 5 and 13 ± 9.8, respectively. The mean pre-hospital time intervals (response, scene, transport) in roads out of the city were higher than those in city streets. There was a significant difference (P = 0.04) in the mortality rates due to RTAs between city streets (n = 46) and roads out of the city (n = 32).

          Conclusions

          In comparison with road traffic accidents on city streets, trauma patients in RTAs on roads out of the city have longer pre-hospital time intervals and more severe injuries; therefore, this group needs more pre-hospital resuscitation interventions.

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          Most cited references37

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          World report on road traffic injury prevention

          M. Peden, R Scurfield, D Sleet (2004)
          Article 0 comments Cited 92 times – based on 0 reviews     Review now
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            Road-traffic-related mortality in Iran: a descriptive study.

            A Montazeri (2004)
            Road traffic accidents are considered to be the second highest cause of mortality in Iran. A study was conducted to describe road-traffic-related mortality data in Iran in a given period. All Iranian mortality data on road traffic accidents between March 1999 and 2000 (one complete Iranian calendar year) were obtained. The main variables studied were deceased's gender, age, education level, status (i.e. driver, car occupant, etc.), cause and place of death. A total of 15?482 individuals died from road traffic accidents in Iran in the study period. A disproportionate number of deceased individuals were male (79%), mostly aged 40 years or less (65%), and who were pedestrians or car occupants (62%). Head injury was the most common cause of road-traffic-related mortality (66%) in males and females of all ages. Following road traffic accidents, 57% of deaths occurred pre-hospital. Head injury is the most common single cause of mortality attributable to road traffic accidents in Iran, and since most deaths occur pre-hospital, it seems many are preventable. To overcome this major public health problem, there is an urgent need to develop a comprehensive injury control policy and strategy in Iran.
            Article 0 comments Cited 64 times – based on 0 reviews     Review now
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              Trauma deaths in a mature urban trauma system: is "trimodal" distribution a valid concept?

              Demetrios Demetriades, G Gruzinski, Landa Ali Salim … (2005)
              Trimodal distribution of trauma deaths, described more than 20 years ago, is still widely taught in the design of trauma systems. The purpose of this study was to examine the applicability of this trimodal distribution in a modern trauma system. A study of trauma registry and emergency medical services records of trauma deaths in the County of Los Angeles was conducted over a 3-year period. The times from injury to death were analyzed according to mechanism of injury and body area (head, chest, abdomen, extremities) with severe trauma (abbreviated injury score [AIS] >/= 4). During the study period there were 4,151 trauma deaths. Penetrating trauma accounted for 50.0% of these deaths. The most commonly injured body area with critical trauma (AIS >/= 4) was the head (32.0%), followed by chest (20.8%), abdomen (11.5%), and extremities (1.8%). Time from injury to death was available in 2,944 of these trauma deaths. Overall, there were two distinct peaks of deaths: the first peak (50.2% of deaths) occurred within the first hour of injury. The second peak occurred 1 to 6 hours after admission (18.3% of deaths). Only 7.6% of deaths were late (>1 week), during the third peak of the classic trimodal distribution. Temporal distribution of deaths in penetrating trauma was very different from blunt trauma and did not follow the classic trimodal distribution. Other significant independent factors associated with time of death were chest AIS and head AIS. Temporal distribution of deaths as a result of severe head trauma did not follow any pattern and did not resemble classic trimodal distribution at all. The classic "trimodal" distribution of deaths does not apply in our trauma system. Temporal distribution of deaths is influenced by the mechanism of injury, age of the patient, and body area with severe trauma. Knowledge of the time of distribution of deaths might help in allocating trauma resources and focusing research effort.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Arch Trauma Res
                Journal ID (iso-abbrev): Arch Trauma Res
                Journal ID (doi): 10.5812/atr
                Journal ID (publisher-id): Kowsar
                Title: Archives of Trauma Research
                Publisher: Kowsar
                ISSN (Print): 2251-953X
                ISSN (Electronic): 2251-9599
                Publication date (Electronic): 01 February 2013
                Publication date (Print): Winter 2013
                Volume: 1
                Issue: 4
                Pages: 166-171
                Affiliations
                [1 ]Faculty of Nursing and Midwifery, Khorasgan (Isfahan) Branch, Islamic Azad University, Isfahan, IR Iran
                [2 ]Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran
                Author notes
                [* ]Corresponding author: Mahdi Mohammadzadeh, Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran. Tel.: +98-3615550026, Fax: +98-3615620634, E-mail: dmmzn58@ 123456gmail.com .
                Article
                DOI: 10.5812/atr.8780
                PMC ID: 3876502
                PubMed ID: 24396772
                SO-VID: 438fdbad-ecd4-4bb0-a3ab-906c93b9307b
                Copyright © Copyright © 2013, Kashan University of Medical Sciences.
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 25 October 2012
                Date revision received : 14 November 2012
                Date accepted : 19 November 2012
                Categories
                Subject: Research Article

                Keywords: accidents,pre-hospital care,traffic,wounds and injuries
                Data availability:
                Keywords: accidents, pre-hospital care, traffic, wounds and injuries

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