A review of patients who suddenly deteriorate in the presence of paramedics

A retrospective cohort study of trauma patients who suddenly deteriorated in the presence of paramedics during 2002. As there was no standard definition, sudden deterioration was defined using a predetermined set of physiological criteria. Patient care record data of patients who suddenly deteriorated were compared with the State Trauma Registry to determine those who sustained hospital defined major trauma. Patient care records where hospital bypass was undertaken were identified and analysed. Ethics committee approval was obtained.There were 2,893 patients that suddenly deteriorated according to predefined criteria. 2,687 (5.1% of the total trauma patients for 2002) were suitable for further analysis. The majority of patients had a sudden decrease in BP (n = 2,463) with 4.3% having hospital defined major trauma. For patients with a sudden decrease in conscious state or a total GCS score of less than 13 (n = 77), 37.7% had hospital defined major trauma; and a sudden increase/decrease in pulse rate and sudden decrease in BP (n = 65), 26.2% had hospital defined major trauma. Only 28 documented incidents of hospital bypass were identified.This study suggests that the incidents of patients suddenly deteriorating in the presence of paramedics are low and the incidence of hospital bypass is not well documented.Evidence for the management of patients who suddenly deteriorate in the presence of a paramedic crew, either at the scene or during transport, is limited. There is no effective guidance as to which types of trauma patients are more likely to deteriorate suddenly and what the appropriate triage strategy is for those patients.There were two significant pre-hospital care questions that remained unresolved following the report of the Ministerial Review of Trauma and Emergency Services in Victoria (MROTESV), Australia. They were, "is mechanism of injury a useful predictor in pre-hospital trauma triage?" and "what is the appropriate triage strategy for patients who sever