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Improved pre-hospital care efficiency due to the implementation of pre-hospital trauma life support (PHTLS) algorithms


Teuben, Michel; Löhr, Nikolaus; Jensen, Kai Oliver; Brüesch, Martin; Müller, Stephan; Pfeifer, Roman; Mica, Ladislav; Pape, Hans-Christoph; Sprengel, Kai (2019). Improved pre-hospital care efficiency due to the implementation of pre-hospital trauma life support (PHTLS) algorithms. European Journal of Trauma and Emergency Surgery:Epub ahead of print.

Abstract

PURPOSE
Pre-hospital trauma life support (PHTLS) includes a standardized algorithm for pre-hospital care. Implementation of PHTLS led to improved outcome in less developed medical trauma systems. We aimed to determine the impact of PHTLS on quality of pre-hospital care in a European metropolitan area. We hypothesized that the introduction of PHTLS was associated with improved efficiency of pre-hospital care for severely injured patients and less emergency physician deployment.
METHODS
We included adult polytrauma (ISS > 15) patients that were admitted to our level one trauma center during a 7-year time period. Patients were grouped based on the presence or absence of a PHTLS-trained paramedic in the pre-hospital trauma team. Group I (no-PHTLS group) included all casualties treated by no-PHTLS-trained personnel. Group II (PHTLS group) was composed of casualties managed by a PHTLS qualified team. We compared outcome between groups.
RESULTS
During the study period, 187,839 rescue operations were executed and 280 patients were included. No differences were seen in patient characteristics, trauma severity or geographical distances between groups. Transfer times were significantly reduced in PHTLS teams than non-qualified teams (9.3 vs. 10.5 min, P = 0.006). Furthermore, the in-field operation times were significantly reduced in PHTLS qualified teams (36.2 vs. 42.6 min, P = 0.003). Emergency physician involvement did not differ between groups.
CONCLUSION
This is the first study to show that the implementation of PHTLS algorithms in a European metropolitan area is associated with improved efficiency of pre-hospital care for the severely injured. We therefore recommend considering the introduction of PHTLS in metropolitan areas in the first world.

Abstract

PURPOSE
Pre-hospital trauma life support (PHTLS) includes a standardized algorithm for pre-hospital care. Implementation of PHTLS led to improved outcome in less developed medical trauma systems. We aimed to determine the impact of PHTLS on quality of pre-hospital care in a European metropolitan area. We hypothesized that the introduction of PHTLS was associated with improved efficiency of pre-hospital care for severely injured patients and less emergency physician deployment.
METHODS
We included adult polytrauma (ISS > 15) patients that were admitted to our level one trauma center during a 7-year time period. Patients were grouped based on the presence or absence of a PHTLS-trained paramedic in the pre-hospital trauma team. Group I (no-PHTLS group) included all casualties treated by no-PHTLS-trained personnel. Group II (PHTLS group) was composed of casualties managed by a PHTLS qualified team. We compared outcome between groups.
RESULTS
During the study period, 187,839 rescue operations were executed and 280 patients were included. No differences were seen in patient characteristics, trauma severity or geographical distances between groups. Transfer times were significantly reduced in PHTLS teams than non-qualified teams (9.3 vs. 10.5 min, P = 0.006). Furthermore, the in-field operation times were significantly reduced in PHTLS qualified teams (36.2 vs. 42.6 min, P = 0.003). Emergency physician involvement did not differ between groups.
CONCLUSION
This is the first study to show that the implementation of PHTLS algorithms in a European metropolitan area is associated with improved efficiency of pre-hospital care for the severely injured. We therefore recommend considering the introduction of PHTLS in metropolitan areas in the first world.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Department of Trauma Surgery
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:11 May 2019
Deposited On:17 May 2019 10:36
Last Modified:25 Sep 2019 00:34
Publisher:Springer
ISSN:1863-9933
OA Status:Closed
Publisher DOI:https://doi.org/10.1007/s00068-019-01141-1
PubMed ID:31079191

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