11.03 Prehospital & Early In-Hospital Trauma Deaths That May Be Preventable With Earlier Hemorrhage Control

S. L. Carroll¹, J. O. Jansen¹, D. W. Dye², W. A. Smedley¹, J. D. Kerby^{1  1}University Of Alabama at Birmingham,Acute Care Surgery/General Surgery,Birmingham, Alabama, USA ²University Of Alabama at Birmingham,Forensic Pathology/Pathology,Birmingham, Alabama, USA

Introduction:
Advances in prehospital care – including techniques such as REBOA, and prehospital transfusion – are prompting a re-evaluation of the concept of which trauma deaths may be preventable. The objectives of this study were to examine early fatalities, in terms of preventability and geographical location, in order to determine whether a case could be made for providing enhanced prehospital trauma care, as available in some European countries.

Methods:
Prehospital and early in-hospital trauma deaths occurring in a single county, in 2017, were retrospectively reviewed. Data were obtained from the Coroner/ME’s Office and analyzed using a novel classification scheme, incorporating anatomic and physiologic criteria present at the scene or on arrival to the ED. A consensus panel of physicians evaluated the anatomic and physiologic survivability, and then classified incidents as non-preventable, probably not preventable, and possibly preventable. Incident locations were mapped using arcGIS^TM and evaluated using drivetime.

Results:
325 trauma deaths were identified. 71% were deemed anatomically non-survivable, 9% survivable, but only with hospital care, 14% survivable with advanced prehospital care, and 2% survivable with basic prehospital care. 35% of incidents were not notified to EMS. 43% of patients had no cardiorespiratory activity at the scene, 8% had activity at the scene or en route, but not on arrival in ED, and 13% had activity on arrival in ED. 38 deaths were deemed possibly preventable, 10 probably not preventable, and 269 non-preventable (8 not assessable).  Most incidents occurred within 20 mins drivetime of the trauma center and were concentrated in certain areas (fig.1).

Conclusion:
There are a number of hemorrhage-related early trauma deaths, which might be amenable to enhanced prehospital care. Furthermore, these cases originated in proximity to the trauma center.  If advanced care had been available in the study cohort, some trauma patients might have survived.