The trauma chain of survival - Each link is equally important (but some links are more equal than others).


In this issue Oliver, Walter and Redmond are shedding some sorely missed light onto two of trauma research's blind spots, those patients that die before they reach hospital, and bystander first aid [1,2]. The epochal study of Hussain and Redmond [3] is revisited, and the – now historical – method is reapplied to a modern material. The findings were, however, even more alarming. The 1987–1990 material contained 46 of 406 (11%) cases in which “the injury severity score and age of the patient suggest that, although injury was severe, death was not inevitable and the probability of survival was probably greater than 50%” [3]. The 2011–2013 material [1] contained 58 of 134 (43%) patients with a probability of survival greater than 50%, applying identical methodology. When applying a modern methodology on a material containing additional patients from the same time frame (2011–2013) the researchers found that approximately 50% of the prehospital trauma deaths were found in individuals with a probability of survival indicating that death could have been avoided [2]. New methodology did not change the dismal findings made with old methods. These studies are sad replications of the findings of Yates from 1977 [4]. In this study, aimed at assessing the rate of airway obstruction in trauma related mortality, the rate of prehospital death was found to be 69/174 (40%). 38 of 69 (55%) had signs of airway obstruction, considered a sign of a possibly preventable death. Oliver, Walter, and Redmond show that a considerable share of trauma deaths occur prehospitally [2]. In other areas prehospital deaths constitute an even larger majority of trauma fatalities [5–8]. This makes efforts to improve hospital treatment of no benefit for this group, although the severely injured will of course benefit from this. Studies from rural areas have shown that 17% of prehospital deaths occur after the EMS has arrived on scene [9]. This suggests that some of these deaths may not only be possibly preventable, but also may be within reach of the health care system. Furthermore, Oliver, Walter and Redmond reports that for 86 to 96% of patients there were bystanders present at the time of EMS arrival [2]. These bystanders and passers-by are in a position to provide life saving first aid, and may prevent deaths that are outside the reach of even the fastest EMS system. Post-mortem studies suggest that 1.8–4.5% of those that die from trauma could have been saved if bystanders had provided an open airway and controlled major haemorrhage [10,11]. In a prospective study from Iraq the estimate was even higher, at 5.8%

DOI: 10.1016/j.injury.2017.04.001

Cite this paper

@article{Bakke2017TheTC, title={The trauma chain of survival - Each link is equally important (but some links are more equal than others).}, author={H{\aa}kon Kv{\aa}le Bakke and T Wisborg}, journal={Injury}, year={2017}, volume={48 5}, pages={975-977} }