Audit on in-hospital mortality of trauma patients: EMS Management and Mismanagement

Background: The investigation of trauma-related mortality is one of the key components in trauma studies and it is used as a performance index and measure of health care quality. Objective: The present study aimed to evaluate the performance of pre-hospital interventions and identify possible mismanagements in dealing with trauma patients transferred by emergency medical services (EMS) to the hospital and died. Methods: This study was conducted in 2019, in Tehran, Iran. All trauma patients who were transferred to the emergency department (ED) of three main referral hospitals, by Tehran EMS and died at the hospital within 24 hours of admission, were studied retrospectively. The required information was collected from the EMS and the hospital records. A panel of experts was asked to identify possible errors based on standards for each patient. Results: During the one-year study period, almost 14000 trauma patients were transported by Tehran EMS to the studied hospitals. Of them, a total of 197 deaths were recorded. The most and least provided services were breathing management (87.3%) and intravenous (IV) fluid therapy (12.2%), respectively. Needle thoracostomy, IV fluids therapy, life supports (basic and advanced cardiac), and airway management had the highest percentage of mismanagement among provided services. Bleeding control and resuscitation were consistent with the recommended standard. Conclusion: In the current study, bleeding control and immobilization was performed appropriately. Needle tracheostomy was not performed at all. Airway management and life supports of the victims were not performed properly.