Study of Pre Hospital Management of Polytrauma Patients by Medical Teams From a Department in the Parisian Region

Trauma is the leading cause of mortality among individuals aged 25-34 years, regardless of the mechanism of injury (road traffic accidents, falls from height, defenestration, ballistic or stab wounds, etc.).

More than 50% of trauma-related deaths occur within the first hour following injury, and over 80% occur within the first 24 hours.

Since the 1970s, the principle that definitive treatment should be initiated within one hour of the beginning of medical care for any life-threatening condition has been introduced. This concept, known as the "Golden Hour," has been applied in many fields, including trauma care, with the assumption that any delay is associated with decreased patient survival.

In the literature, prehospital time intervals do not consistently demonstrate a clear impact on mortality, with study results often being contradictory (1-11). A French study conducted within a SMUR-type system by Tobias Gauss in 2019 reported a significant linear increase in mortality associated with longer prehospital time (1).

In contrast, other American and European studies (3,7) did not find a significant association between prehospital care time and short- or long-term mortality, in healthcare systems that are not always comparable to the French SMUR model.

Overall, studies on this topic have yielded heterogeneous and sometimes conflicting results.

Nevertheless, these time intervals appear to play a more critical role in patients with penetrating trauma or with initial arterial hypotension.

The major challenge in the prehospital setting is therefore to rapidly identify patients for whom prolonged on-scene management would have a detrimental impact on survival.

The physician must then determine the optimal amount of time to spend at the scene during SMUR intervention, based on the risk-benefit balance for the patient.

Some patients will require longer prehospital management in order to perform life-saving procedures, whereas for others, for whom definitive treatment is exclusively hospital-based, any delay will be unacceptable.

Primary outcomes

• Mortality [at day 0]: All-cause in-hospital mortality within 24 hours

Secondary outcomes

• Length of hospital stay and neurological outcome [Up to one year]: Total duration of hospital stay (in days) and neurological outcome at hospital discharge.

Sex: All, ages: 15 Years to any

Inclusion Criteria:

* Age ≥ 15 years (upper age limit for the pediatric population)
* Severe trauma, defined as any road traffic accident, defenestration, fall from a height greater than 3 meters, stab wound, or ballistic injury requiring medically supervised transport to one of the Level 1 trauma centers in the Île-de-France region
* Prehospital management provided by one of the SMUR teams in the Essonne department (91)

Exclusion Criteria:

* Patients declared dead at initial medical contact, without resuscitation initiated, or with resuscitation attempted and subsequently discontinued (non-return of spontaneous circulation)
* Secondary inter-hospital transfer from another hospital to a Level 1 trauma center
* Transport to a hospital for local computed tomography imaging only (without direct admission to a Level 1 trauma center)
* Cases regulated (dispatched) by emergency coordination centers other than the Essonne (91) medical dispatch center

• Romain BARDELAY, MD, Principal investigator, Centre Hospitalier Sud Francilien