Head Injury

Training paramedics to implement prehospital guidelines for traumatic brain injury (TBI) has dramatically improve survival in patients with severe head trauma, new data show. Results from the Excellence in Prehospital Injury Care (EPIC) study, which include more than 21,000 TBI patients, show a doubling of the survival rate in severe TBI victims and a tripling of the survival rate in those who were intubated with pre-hospital guideline implementation by paramedics.

Surviving versus dying

In medicine, improve outcomes are almost always incremental; also very few things that we do in medicine improve the ultimate outcome; which is surviving versus dying. This is a quantum leap. This is not incremental, Daniel Spaite, MD, professor of emergency medicine at the University of Arizona in Tucson, who led the study.

In the study, more than 11,000 paramedics from 130 EMS agencies across Arizona took a 2-hour training session on prehospital TBI treatment guidelines, which emphasize avoidance/treatment of hypoxia, prevention/correction of hyperventilation, and avoidance/treatment of hypotension.

The results are astounding and show that the first 20 minutes of care dramatically impact the final outcome, Spaite said. The last 40 years of attempts to find ways to improve brain injury outcomes in the prehospital setting is literally a graveyard full of fail drugs and procedures, they add.

In a statement, Patrick Bellgowan, PhD, program director at the National Institute of Neurological Disorders and Stroke; said the results demonstrate the significance of conducting studies; so in real world settings and brings a strong evidence base to the guidelines. It suggests we can systematically increase the chances of saving lives of thousands of people who suffer severe traumatic brain injuries.

The Emergency Physician

Reach for comment, Robert Glatter, MD, an emergency physician at Lenox Hill Hospital in New York City; note that this is the first “major prehospital study to evaluate the impact of national prehospital TBI treatment guidelines; which were develop after years of research superseding decades of management base on outdate protocols.

Implementing simple interventions by EMS providers; so addressing hypoxia, hypotension, and avoiding hyperventilation can make a clear difference in outcome in those with severe neurological impairment; hence after TBI, said Glatter, who was not involve with the current study.

Simply put, he added, what we do in the early stages after acute injury; so is an extension of principles of critical care that continue in the hospital. By focusing and adhering to principles; so that maximize oxygenation, reduce hypotension, and avoid hyperventilation, we can make a difference in who survives.