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    Severe head injury patients have increased survival rates when EMS follow guidelines

    May 9, 2019
    Photo by Alan Batt
    Photo by Alan Batt

    Training emergency medical services (EMS) agencies to use prehospital guidelines for traumatic brain injury (TBI) patients is likely to save more lives among patients with severe head trauma, reports the National Institutes of Health, which funded the study of more than 21,000 people. The findings were published in JAMA Surgery.  

    “This demonstrates the significance of conducting studies in real-world settings and brings a strong evidence base to the guidelines,” said Patrick Bellgowan, Ph.D., program director at NINDS in the statement. “It suggests we can systematically increase the chances of saving lives of thousands of people who suffer severe traumatic brain injuries.”

    The guidelines for prehospital management of TBI (based on numerous observational studies) focus on preventing low oxygen, low blood pressure, and hyperventilation in people with head injury. Controlling those factors before patients arrived at the hospital could improve survival – nearly doubling and tripling survival rates for certain patients – but actual adherence to the guidelines had not been examined, said NIH.

    The Excellence in Prehospital Injury Care (EPIC) Study, led by Daniel Spaite, M.D., professor of emergency medicine at the University of Arizona in Tucson, trained EMS agencies across Arizona in the TBI guidelines and compared patient outcomes before and after the guideline implementation. All patients in the study experienced head injury with loss of consciousness. The EPIC study is the first time that the guidelines were assessed in real-world conditions.

    Although using the guidelines did not affect overall survival of the entire group, which included patients who had moderate, severe, and critical injuries, they did help to double the survival rate of people with severe TBI and triple the survival rate in severe TBI patients who had to be intubated by EMS personnel. The guidelines were also associated with an overall increase in survival to hospital admission.

    “We found a therapeutic sweet spot and showed that the guidelines had an enormous impact on people with severe TBI,” said Dr. Spaite. “The guidelines did not make a difference in the moderate TBI group because those individuals would most likely have survived anyway and, unfortunately, the extent of injuries sustained in many critical patients was too extreme to overcome.”

    Bentley Bobrow, M.D., professor of emergency medicine at the University of Arizona and co-principal investigator for the study said, “It was exciting to see such dramatic outcomes resulting from a simple two-hour training session with EMS personnel.”  

    NIH added that although the guidelines provide specific recommendations for oxygen levels and blood pressure, researchers will examine whether those ranges should be revised. Also, more research is needed to determine the best strategies for airway management and breathing support to optimize ventilation. Additional studies will investigate the best methods for national and global adoption of the TBI guidelines.