Investigating the pre-hospital emergency situation and its related factors in trauma patients transferred to Porsina Medical Training Center in Rasht in 2013-2014

Dissertation

To receive a master's degree in intensive care nursing

Introduction: Today, the prevention and treatment of traumatic injuries is a fundamental problem of public health. Good management in the care and treatment of these patients can greatly prevent the occurrence of secondary injuries and death and disability of these patients, and reduce economic costs and social problems. reduce it. The aim of this study was to determine the pre-hospital emergency situation and its related factors in trauma patients transferred to the Porsina Medical Education Center. Materials and methods: In this descriptive-analytical cross-sectional study, the 115 emergency situation and its related factors in 577 trauma patients transferred to the Porsina Medical Education Center, by easy sampling and using a checklist The researcher was examined in three shifts. To analyze the data, one-way analysis of variance, Spearman test and t-test were used, as well as multiple linear regression models were used to examine the predictive factors of actions.

Results: The results of the research showed that accidents (82.7%) were the most common mechanism of trauma and the most time spent was related to transferring the patient from the scene to the hospital (14.57±9.75 minutes) and the shortest time between receiving the message and reaching the scene was (5.6±4.85 minutes). The actions provided were in the field of general care (60.7%), hemodynamics (38.8%), neurological (26%), respiratory (30.5%). According to the linear regression of occupational injuries in the general field (7/09), age >60 years In the nervous area (7/53), the time of the incident from 8 am to 12 noon (5/95), from 4 to 8 am (8/7), age 30-39 years (7/16) and the time between the scene and the hospital (0/41) in the respiratory area had a positive effect on the emergency situation, while knife injuries (-15/92), evening shift (-4/58) in the nervous area and the presence of Farai (-1/11) and inner-city accidents (-9/04) in the respiratory field have had a negative impact on the pre-hospital emergency care situation. In the meantime, no significant relationship was found between any of the hemodynamic intervention factors.

Conclusion: Considering that the pre-hospital emergency measures in most areas are relatively far from the international standard, the results of this research can provide information about the situation available to managers to prevent injury by improving prevention programs such as road improvement, GPS system, reducing working hours, increasing the skills of personnel and providing them with necessary equipment.

Keywords: emergency medical services. rtl;">-1 Introduction:

      Today, trauma has been more and more noticed as an important cause of death and disability in developed and developing countries. (1 and 2) Socio-economic development, change in lifestyle and increase in life expectancy have led to tragic changes in the type of diseases in countries. (3) Every year, millions of people suffer from accidents, falls, sports injuries, occupational injuries, knives. (4) In fact, injuries are the most common cause of death among people aged 1 to 34, which leads to disability and loss of life years. (5) WHO has predicted that by 2020, the death rate due to injuries will be the sixth cause of death in the world and the second cause of disability according to the years of life lost (DALY[1]) in countries will be developing. (6) Among them, road traffic accidents are the most common basic problem that threatens public health in developing countries as well as in industrialized countries. (7) Statistics show that Iran is among the first countries in the world in terms of accidents and incidents. In 2006, the number of deaths caused by road traffic accidents alone was 2645 (20 cases per 100,000 people). (10) In Gilan, due to the high population density of 171 people per square kilometer, the geographical location and the traffic of light and heavy vehicles, the highest number of fatal accidents occurred in Gilan.According to a study in Gilan that was conducted from Mehr 1386 to August 1387, it is estimated that more than 3598 cases of traumatic injuries occurred, which led to people being hospitalized (7) and men suffer from these injuries almost twice as often as women (11). The injured person imposes exorbitant costs on society and families every year. (12) Today, the prevention and treatment of traumatic injuries is a major public health problem in most countries of the world. (13) The annual costs of traumatic injuries in low-income and middle-income countries are about 65 billion dollars, which is more than the annual amount received by developed countries. (5) The care, treatment, and rehabilitation of the injured imposes many direct and indirect costs on the society. (4) The estimated cost includes lost wages, treatment costs, insurance costs, motor accident costs, and indirect costs related to job loss. (14) It is estimated that the financial damage caused by traumatic brain injuries in the United States America is about 100 billion dollars annually. (8) In a study by Aiti et al. in 2004 in Iran, which was conducted with the aim of investigating the cost of vehicle damage, they showed that more than 6000 billion Rials have been harmed to the country's economy. style="direction: rtl;">     The most important way to prevent deaths and reduce costs in traumatic patients is the quality of providing pre-hospital care. Although it seems that most pre-hospital deaths are inevitable, but preventing deaths even in a very small proportion is very valuable both medically and economically (16) In a study conducted by Montazeri between March 1999 and 2000, 15482 deaths were caused by accidents. It happened in Iran that because most of these deaths were in the pre-hospital stage, it seems that they can be prevented (17) In another study in Iran, 17% of the deaths caused by trauma that were referred to the forensic medicine were due to internal bleeding, most of which were considered preventable (11) In another similar study, cited by Sempliz1 et al., which was conducted in Montreal, they concluded that out of 360 patients with severe trauma who were treated by the emergency medical system were treated, 62% of deaths were preventable, and in another study, cited by Papadopoulos and his colleagues, they found that 87.4% of deaths from 82 victims of trauma were definitely preventable. has been far from the center by the helicopter or hospital staff. (19) This fact is especially evident in situations where primary care is provided quickly and correctly. In fact, the greatest benefits of care and treatment of these patients can be obtained with timely vital interventions. (8) Even though primary prevention is still recognized as one of the important ways to reduce the burden of injuries and damages, it has been determined in several studies that many deaths and long-term disabilities can be prevented by strengthening trauma centers and emergency care. (20)

Two important factors to reduce trauma-related deaths and complications in different countries are the prevention of trauma and the quality of systematic pre-hospital care. and it is performed by trained people. (12) The main benefits of pre-hospital care are more related to the second stage, i.e. after the accident, and that is when the way of providing care can accelerate or stop the stages leading to death or permanent disability of a person. Without pre-hospital care, many patients who have a chance to survive, die at the scene of the accident or on the way to the hospital.