Prehospital trauma care in Tehran: potential areas for improvement

To evaluate the existing prehospital trauma care system in Tehran, Iran.

This was a cross-sectional study in which all trauma-related dispatches of Tehran's emergency medical services (EMS) system were evaluated-during 18 randomly selected days from September 22,1997, to March 17,1998. Emergency medical technicians completed a checklist for all trauma cases, and the criteria for this performance evaluation were different partial time intervals in each dispatch and different procedures that had been done for the patients.

The means of the "dispatch-beginning-to-scene-arrival interval" and "scene-arrival-to-scene-leaving interval" were 10 and 18 minutes, respectively (median: 10 minutes, range 0-55 minutes for the first; and median: 15 minutes, range 1-165 minutes for the second time interval). The mean of the "dispatch-beginning-to-hospital-arrival interval" was 45 minutes (median: 42 minutes, range: 5-170 minutes). Among advanced life support (ALS) procedures that include cardiac monitoring, intratracheal intubation, intravenous fluid therapy, nasogastric tube insertion, defibrillation, and tracheostomy, only intravenous fluid therapy had been administered for the patients. The patients, however, had received different kinds of basic life support (BLS) that include initial evaluation, bleeding control, oxygen administration, splinting, suction use, and cardiopulmonary resuscitation.

The prolonged response, scene, and dispatch-beginning-to-hospital-arrival intervals compared with those for a developed EMS system indicate one potential area for improvement. Furthermore, significant differences in the field of prehospital care (conducting no ALS procedure) showed that ambulance equipment and training of EMS personnel are two other potential sites for improvement.