Pre-Hospital Management and Patient Outcome in Severe Traumatic Head Injury

Conclusions Analysis failed to support the hypothesis that persons with severe traumatic head injury will benefit from the attendance of intensive care paramedics. Intensive care paramedics were associated with increased scene time, and scene time greater than 10 minutes was a significant predictor of poor outcome. The study found no significant correlation between pre-hospital endotracheal intubation and improved oxygen saturation levels or time to endotracheal intubation and improved outcome.Patients who experienced pre-hospital hypoxaemia demonstrated poorer outcomes than those who did not experience pre-hospital hypoxaemia. A significant correlation between endotracheal intubation and reduction in hypoxaemia was not demonstrated. Persons with severe traumatic head injury should have oxygen saturations maintained at 95% or greater during pre-hospital management and all ambulance vehicles should be equipped with pulse oximetry monitoring devices. Improved outcomes were demonstrated in cases where time at scene was less than or equal to 10 minutes. Time at scene should be limited, where possible, to 10 minutes and patients expedited to a trauma facility. Outcomes for those who received pre-hospital fluid resuscitation were poorer than those who did not receive fluid resuscitation, regardless of the presence or absence of hypotension. Further research is required to investigate the efficacy of pre-hospital fluid volume resuscitation in persons with severe traumatic head injury.