Prehospital procedures before emergency department thoracotomy: "scoop and run" saves lives

The role of prehospital healthcare personnel in the management of acutely injured patients is rapidly evolving. However, the performance of prehospital procedures on unstable, penetrating trauma patients remains controversial. The objective of this study is to test the hypothesis that survival of most critically injured penetrating trauma patients requiring emergency department thoracotomy (EDT) would be improved if procedures were restricted until arrival to the trauma bay.

A retrospective chart review on 180 consecutive penetrating trauma patients (2000-2005) who underwent EDT was performed. Patients were divided into two groups by mode of transportation and compared on the basis of demographics, clinical and physiologic parameters, prehospital procedures, and survival.

Eighty-eight patients arrived by emergency medical services (EMS), and 92 were brought by police or private vehicle. Groups were similar with respect to demographics. Seven of 88 (8.0%) EMS-transported patients survived until hospital discharge, and 16 of 92 (17.4%) survived after police or private transportation. Overall, 137 prehospital procedures were performed in 78 of 88 (88.6%) EMS-transported patients, but no police- or private-transported patient underwent field procedures. Multivariate logistic regression analyses identified prehospital procedures as the sole independent predictor of mortality. For each procedure, patients were 2.63 times more likely to die before hospital discharge (OR = 0.38, 95% CI = 0.18-0.79, p = 0.0096).

The performance of prehospital procedures in critical, penetrating trauma victims had a negative impact on survival after EDT in our study population. Paramedics should adhere to a minimal or "scoop and run" approach to prehospital transportation in this setting.