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Trained Lay First Responders Reduce Trauma Mortality: A Controlled Study of Rural Trauma in Iraq

  • Mudhafar Karim Murad (a1) and Hans Husum (a2)

Abstract

Introduction:

Recent studies demonstrate that early, in-field, basic life support by paramedics improves trauma survival where prehospital transport times are long. So far, no case-control studies of the effect of layperson trauma first responders have been reported. It was hypothesized that trained layperson first responders improve trauma outcomes where prehospital transit times are long.

Methods:

A rural prehospital trauma system was established in the mine and war zones in Iraq, consisting of 135 paramedics and 7,000 layperson trauma first responders in the villages. In a non-randomized clinical study, the outcomes of patients initially managed in-field by first-responders were compared to patients not receiving first-responder support.

Results:

The mortality rate was significantly lower among patients initially managed in-field by first responders (n = 325) compared to patients without first-responder support (n = 1,016), 9.8% versus 15.6%, 95% CI = 1.3−10.0%.

Conclusions:

Trained layperson first responders improve trauma outcomes where prehospital evacuation times are long. This finding demonstrates that simple interventions done early—by any type of trained care provider—are crucial for trauma survival. Where the prevalence of severe trauma is high, trauma first-responders should be an integral element of the trauma system.

Copyright

Corresponding author

PO Box 80, N-9038 University Hospital North Norway, Tromsoe, Norway E-mail: husumhans@gmail.com

References

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1.Mathers, CD, Joncar, D: Updated projections of global mortality and burden of disease, 2002-2030: data sources, methods, and results. Available at http://www.who.int/healthinfo/statistics/bod_projections2030_paper.pdf. Accessed 30 March 2009.
2.Ike, SO: The health workforce crisis: The brain drain scourge. Niger J Med 2007;16(3):204211.
3.McCord, C, Mbaruku, G, Pereira, C, Nzabukakwa, C, Bergstrom, S: The quality of emergency obstetrical surgery by assistant medical officers in Tanzanian district hospitals. Health Aff (Millwood) 2009;28(5):876885.
4.Thürer, D: Dunant's pyramid: Thoughts on the “humanitarian space”. Int Red Cross Rev 2007;89(865):5960.
5.Burnham, G, Lafta, R, Doocy, S, Roberts, L: Mortality after the 2003 invasion of Iraq: A cross-sectional cluster sample survey. Lancet 2006;368(9545):14211428. Erratum in: Lancet 2009;373:810.
6.Murad, M, Husum, H: What makes a survivor? Ten-year results from a pre-hospital trauma system in Iraq. Bull World Health Org 2010.
7.Mock, C, Tiska, M, Adu-Ampofo, M, Boakye, G: Improvement in prehospital trauma care in an African country with no formal emergency medical services. J Trauma 2002;53(1):9097.
8.Husum, H, Gilbert, M, Wisborg, T: Training prehospital trauma care in low-income countries: the “Village University” experience. Med Teach 2003;25(2):142148.
9.Husum, H, Gilbert, M, Wisborg, T, Heng, YV, Murad, M: Rural prehospital trauma systems improve trauma outcome in low-income countries: A prospective study from North Iraq and Cambodia. J Trauma 2003;54(6):11881196.
10.Champion, HR, Copes, WS, Sacco, WJ, Lawnick, MM, Keast, SL, Bain, LW Jr, Flanagan, ME, Frey, CF: The Major Trauma Outcome Study: Establishing national norms for trauma care. J Trauma 1990;30(11):13561365.
11.Husum, H, Gilbert, M, Wisborg, T, Heng, YV, Murad, M: Respiratory rate as prehospital triage tool in rural trauma. J Trauma 2003;55(3):466470.
12.Zweig, MH, Campbell, G: Receiver-Operating Characteristic (ROC) Plots: A fundamental evaluation tool in clinical medicine. Clin Chem 1993;39(4):561577.
13.Altman, DC: Practical Statistics for Medical Research. London: Chapman & Hall/CRC, 1999.
14.Agresti, A: Categorical Data Analysis. New Jersey: John Wiley & Sons; 2002.
15.JMP 6.0.2. SAS Institute Inc: Cary, NC, 2007.
16.Shah, RK, Thapa, VK, Jones DHA, Owen: Improving primary orthopaedic and trauma care in Nepal. Edu Health 2003;16(3):348356.
18.Liberman, M, Mulder, D, Lavoie, A, Denis, R, Sampalis, JS: Multicenter Canadian study of preshospital trauma care. Ann Surg 2003;237(2):153160.

Keywords

Trained Lay First Responders Reduce Trauma Mortality: A Controlled Study of Rural Trauma in Iraq

  • Mudhafar Karim Murad (a1) and Hans Husum (a2)

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