Håkon Kvåle Bakke

A systematic literature review on first aid provided by laypeople to trauma victims

Death from trauma is a significant and international problem. Outcome for patients suffering out‐of‐hospital cardiac arrests is significantly improved by early cardiopulmonary resuscitation. The usefulness of first aid given by laypeople in trauma is less well established. The aim of this study was to review the existing literature on first aid provided by laypeople to trauma victims and to establish how often first aid is provided, if it is performed correctly, and its impact on outcome. A systematic review was carried out, according to preferred reporting items for systematic reviews and meta‐analysis (PRISMA) guidelines, of all studies involving first aid provided by laypeople to trauma victims. Cochrane, Embase, Medline, Pubmed, and Google Scholar databases were systematically searched. Ten eligible articles were identified involving a total of 5836 victims. Eight studies were related to patient outcome, while two studies were simulation based. The proportion of patients who received first aid ranged from 10.7% to 65%. Incorrect first aid was given in up to 83.7% of cases. Airway handling and haemorrhage control were particular areas of concern. One study from Iraq investigated survival and reported a 5.8% reduction in mortality. Two retrospective autopsy‐based studies estimated that correct first aid could have reduced mortality by 1.8–4.5%. There is limited evidence regarding first aid provided by laypeople to trauma victims. Due to great heterogeneity in the studies, firm conclusions can not be drawn. However, the results show a potential mortality reduction if first aid is administered to trauma victims. Further research is necessary to establish this.

Rural High North: A High Rate of Fatal Injury and Prehospital Death

BackgroundFinnmark County is the northernmost county in Norway. For several decades, the rate of mortality after injury in this sparsely inhabited region has remained above the national average. Following documentation of this discrepancy for the period 1991–1995, improvements to the trauma system were implemented. The present study aims to assess whether trauma-related mortality rates have subsequently improved.MethodsAll injury-associated fatalities in Finnmark from 1995–2004 were identified retrospectively from the National Registry of Death and reviewed. Low-energy trauma in elderly individuals and poisonings were excluded.ResultsA total of 453 cases of trauma-related death occurred during the study period, and 327 of those met the inclusion criteria. Information was retrievable for 266 cases. The majority of deaths (86%) occurred in the prehospital phase. The main causes of death were suicide (33%) and road traffic accidents (21%). Drowning and snowmobile injuries accounted for an unexpectedly high proportion (12 and 8%, respectively). The time of death did not show trimodal distribution. Compared to the previous study period, there was a significant overall decline in injury-related mortality, yet there was no change in place of death, mechanism of injury, or time from injury until death.ConclusionsChanges in injury-related mortality cannot be linked to improvements in the trauma system. There was no change in the epidemiological patterns of injury. The high rate of on-scene mortality indicates that any major improvement in the number of injury-related deaths lies in targeted prevention.

Bystander first aid in trauma - prevalence and quality: a prospective observational study

Bystander first aid and basic life support can likely improve victim survival in trauma. In contrast to bystander first aid and out‐of‐hospital cardiac arrest, little is known about the role of bystanders in trauma response. Our aim was to determine how frequently first aid is given to trauma victims by bystanders, the quality of this aid, the professional background of first‐aid providers, and whether previous first‐aid training affects aid quality.

Fatal injury as a function of rurality-a tale of two Norwegian counties

BackgroundMany studies indicate rural location as a separate risk for dying from injuries. For decades, Finnmark, the northernmost and most rural county in Norway, has topped the injury mortality statistics in Norway. The present study is an exploration of the impact of rurality, using a point-by-point comparison to another Norwegian county.MethodsWe identified all fatalities following injury occurring in Finnmark between 2000 and 2004, and in Hordaland, a mixed rural/urban county in western Norway between 2003 and 2004 using data from the Norwegian Cause of Death Registry. Intoxications and low-energy trauma in patients aged over 64 years were excluded. To assess the effect of a rural locale, Hordaland was divided into a rural and an urban group for comparison. In addition, data from Statistics Norway were analysed.ResultsFinnmark reported 207 deaths and Hordaland 217 deaths. Finnmark had an injury death rate of 33.1 per 100,000 inhabitants. Urban Hordaland had 18.8 deaths per 100,000 and rural Hordaland 23.7 deaths per 100,000. In Finnmark, more victims were male and were younger than in the other areas. Finnmark and rural Hordaland both had more fatal traffic accidents than urban Hordaland, but fewer non-fatal traffic accidents.ConclusionsThis study illustrates the disadvantages of the most rural trauma victims and suggests an urban-rural continuum. Rural victims seem to be younger, die mainly at the site of injury, and from road traffic accident injuries. In addition to injury prevention, the extent and possible impact of lay people’s first aid response should be explored.

Fatal injuries in rural and urban areas in northern Finland: a 5-year retrospective study

Finland has the fourth highest injury mortality rate in the European Union. To better understand the causes of the high injury rate, and prevent these fatal injuries, studies are needed. Therefore, we set out to complete an analysis of the epidemiology of fatal trauma, and any contributory role for alcohol, long suspected to promote fatal injuries. As a study area, we chose the four northernmost counties of Finland; their mix of remote rural areas and urban centres allowed us to correlate mortality rates with ‘rurality’.

Fatal injury caused by low-energy trauma – a 10-year rural cohort

Death after injury with low energy has gained increasing focus lately, and seems to constitute a significant amount of trauma‐related death. The aim of this study was to describe the epidemiology of deaths from low‐energy trauma in a rural Norwegian cohort.

Do pre-hospital poisoning deaths differ from in-hospital deaths? A retrospective analysis

BackgroundMost fatal poisonings occur outside the hospital and the victims found dead. The purpose of this study was to determine the general pattern and patient demographics of fatal poisonings in Northern Finland. In particular, we wanted to analyze differences between pre-hospital and in-hospital deaths.MethodsAll fatal poisonings that occurred in Northern Finland in 2007–2011 were retrieved from the Cause of Death Registry provided by Statistics Finland. We noted the patient demographics, causal agents, and other characteristics of the poisoning events.ResultsA total of 689 fatal poisonings occurred during the study period, of which only 42 (6.1%) reached the hospital alive. Those who died pre-hospital were significantly younger (50 vs. 56 years, p = 0.04) and more likely to be male (77% vs. 57%, p = 0.003). Cardiopulmonary resuscitation was attempted less often in pre-hospital cases (9.9% vs. 47.6%, p < 0.001). Ethanol was more frequently the main toxic agent in pre-hospital deaths (58.4% vs. 26.2%, p < 0.001), and multiple ingestions were more common (52.2% vs. 35.7%, p < 0.001) in pre-hospital deaths.DiscussionMost of the pre-hospital fatal poisoning victims are found dead and the majority of in-hospital victims are admitted to hospital in an already serious condition. According to results of this and former studies, prevention seems to be the most important factor in reducing deaths due to poisoning.ConclusionsThe majority of poisoning-related deaths occur pre-hospital and are related to alcohol intoxication and multiple ingestions.

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 researchs 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%

We need to include bystander first aid in trauma research

BackgroundThe chain of trauma survival is a concept that originated in the area of out-of-hospital cardiac arrest (OHCA) and was adapted to the treatment of trauma. In out-of-hospital cardiac arrest research into bystander first aid has resulted in improved outcome. Whereas, in trauma research the first link of the chain of survival is almost ignored.MethodsIn OHCA, cardiopulmonary resuscitation (CPR) from bystanders has been subject of a vast amount of research, as well as measures and programs to raise the rate of bystander CPR to cardiac arrest victims. These efforts have resulted in improved survival. The research effort has been well grounded in the research community, as demonstrated by its natural inclusion in the uniform reporting template (Utstein) for the treatment of OHCA. In trauma the bystander may contribute by providing an open airway, staunch bleedings, or prevent hypothermia. In trauma however, while the chain of survival has been adopted along with it distinct links, including bystander first aid, the consensus-based uniform reporting template for trauma (the Utstein template) does not include the bystander first aid efforts. There is extremely little research on what first aid measures bystanders provide to trauma victims, and on what impact such measures have on outcome. An important step to improve research on bystander first aid in trauma would be to include this as part of the uniform reporting template for traumaConclusionThe lack of research on bystander first aid makes the first link in the trauma chain of survival the weakest link. We, the trauma research community, should either improve our research and knowledge in this area, or remove the link from the chain of survival

First-aid training in school: amount, content and hindrances

To increase knowledge and competence about first aid in the population, first‐aid instruction is included in primary and secondary school curricula. This study aimed to establish how much time is spent on first‐aid training, which first‐aid measures are taught, and which factors prevent teachers from providing the quantity and quality of first‐aid training that they wish to give.