The peer review about the traffic fatalities and investigation of preventable trauma death in Chiba prefecture in 2009

Introduction: Preventable trauma death (PTD) sometimes occurs in the Japanese emergency medical service (EMS). Evaluating the quality of treatment given to trauma victims is important for elucidating the problems and determining means of improvement.<BR>Objective: To evaluate the time passage of emergency medical activity and its quality, to show the proportion of PTD cases, and to clearly reveal problems inherent in the latest emergency system.<BR>Methods: We conducted a questionnaire-based survey of police departments, fire departments, and hospitals in Chiba prefecture to investigate emergency activities involving 196 fatalities caused by traffic accidents. We then selected 87 victims who still had vital signs at first contact with emergency medical teams, and investigated the emergency medical activities and the time passage of the victims. Following a peer review conference to elucidate problems, victims were classified as PTD, ‘suspected PTD’, or ‘impossible to save’.<BR>Results: Average time from the accident to first contact with a doctor was 44 min 18 s. Four cases (4.6%) were classified as PTD and 12 (13.8%) as suspected PTD. Cause of death for 9 cases (4 PTD, 12 suspected PTD) was bleeding from the trunk, 6 of which were transported to an emergency critical care center (ECCC). The problems identified were delays of blood transfusion, surgery, and transcatheter arterial embolization and overly invasive surgery. Of the 9 cases of bleeding from the trunk, 3 cases deemed severe by EMS personnel were not transported to an ECCC and subsequently died. Six of the 16 cases of PTD or suspected PTD had stable vital signs and normal consciousness in the prehospital setting and were transported to facilities other than an ECCC and subsequently died.<BR>Discussion: The main problems identified were too lengthy delay between the accident and treatment, under-triage in the prehospital setting, and PTD occurring even in an ECCC. An integrated approach to handling traffic accident victims is required, and should consist of a doctor delivery system in the early response phase, selection of an ECCC by EMS personnel in cases of severe trauma, assignment of a higher triage category for victims with injuries to the trunk, and a trauma care center system employing specialized medical personnel to receive severely injured patients.<BR>Conclusion: The EMS should be revised to provide a doctor delivery system for early-phase response, assignment of a higher triage category for victims with injuries to the trunk, and the establishment of a trauma care center system.