Prehospital trauma care reduces mortality. Ten-year results from a time-cohort and trauma audit study in Iraq

In the study period from 1997 to 2006, 2,788 patients injured by land mines, war, and traffic accidents were managed by a chain-of-survival trauma system where non-graduate paramedics were the key care providers. The study was conducted with a time-period cohort design.37% of the study patients had serious injuries with Injury Severity Score ≥ 9. The mean prehospital transport time was 2.5 hours (95% CI 1.9 - 3.2). During the ten-year study period trauma mortality was reduced from 17% (95% CI 15 -19) to 4% (95% CI 3.5 - 5), survival especially improving in major trauma victims. In most patients with airway problems, in chest injured, and in patients with external hemorrhage, simple life support measures were sufficient to improve physiological severity indicators.In case of long prehospital transit times simple life support measures by paramedics and lay first responders reduce trauma mortality in major injuries. Delegating life-saving skills to paramedics and lay people is a key factor for efficient prehospital trauma systems in low-resource communities.The epidemic of trauma is accelerating. Injury is now the fourth leading cause of global deaths, and up to 2030 WHO estimates a further 40% increase in trauma fatalities. Almost 90% of injury deaths occur in low- and middle-income countries [1]. Who is to manage this heavy load of trauma - in disastrous events as well as chronic emergencies like the land mine epidemic? Studies of Western trauma scenarios consistently report that reduced prehospital transport times and level I trauma centers and are the essential components of a good trauma system [2]. However, helicopter evacuations and high-cost surgical centers are not feasible in low-income societies and in countries where the social fabric is broken by war. In our time, local wars and natural disasters especially hit low-resource communities and here the "scoop-and run-for-the hospital" strategy hardly fits. There is thus an urgent need to develop trauma system