Are prehospital deaths from trauma and accidental injury preventable? A summary report 25 Calculating the probability of survival (median 6 minutes), although these data were only available for 50 cases. However, this time The average ISS was 38.3. Twenty-nine deaths in frame adds to the only detail we have about the both the current and previous study had an ISS therapeutic vacuum – in 95.5 per cent of cases a of 75 (the maximum possible and considered not passer-by was with the injured person, but without survivable). An ISS greater than 15 is considered professional support. a major trauma. In the current study, 22 deaths had an ISS of less than 15, compared to 14 in the The majority of calls for assistance were made by previous study. a bystander or passer-by (85.1 per cent, n = 114), and in 11 cases (8.2 per cent) by someone The probability of survival remained high in both involved in the incident. studies. In 1994, 39.5 per cent (n = 60) of cases had a probability of survival greater than 50 per When we exclude those who were found dead, cent, compared to 43.3 per cent of people in the a first aid intervention was attempted in 43.1 per present study (n = 58). cent (n = 31) of cases. When including those found dead, in only two additional cases was an The presence of airway obstructions alone was intervention attempted. lower in the present study (19.4 per cent, n = 26) than previously (58.6 per cent, n = 89). In addition, Types of intervention which might help of these 26 deaths, 20 (76.9 per cent) also had a neurological injury, which is similar to the Although the presence of airway obstruction proportion in the previous study (79.8 per cent, alone was slightly lower in the current study than n = 71). Overall, neurological injury was noted previously, the presence of neurological injury and in 102 deaths (76.1 per cent). Similarly, in 1994, neurological injury with airway obstruction was 113 deaths were associated with neurological similar between the studies. Therefore, the original injury (74.3 per cent). recommendation from 1994 – to maintain airways as an important intervention – still stands. Bystander presence However, the current study places greater Data on the presence of a bystander, and how the emphasis on the need to provide ventilatory call for assistance was made, were not collected intervention when a head injury has occurred, in the original 1994 study. This was addressed particularly due to the subsequent physiological in the current study, as it allows for speculation response to brain injury, known as impact brain around the moments after injury and the possibility apnoea. If the airway is supported during this for first aid intervention. time, then death from prolonged apnoea may be avoided (Wilson et al. 2016). Oliver and Walter A bystander was on the scene during or (2016) note that this critical phase of a head injury immediately after the point of injury in 44.8 per takes place in the first 10 minutes, although they 8 cent of deaths (n = 60). For an additional 20 also state that this is an arbitrary time reference people (14.9 per cent), a bystander was on the (Atkinson 2000). scene between minutes and an hour later. A passer-by was on the scene before the emergency The authors of the present study note the services in 95.5 per cent of cases. importance of the role of the bystander or passer-by in supporting the airway and controlling The average time taken for the emergency bleeding. services to arrive after call-out was 8.2 minutes 8 The time from injury to discovery is a subjective assessment of the time from the point of injury to someone being on the scene, based on the available evidence.