Are prehospital deaths from trauma and accidental injury preventable? A summary report 27 Table 2. Status of injured person on discovery Cheshire Manchester (City) % (number) % (number) Found dead 46 (62) 48 (21) Dead at the scene 43 (58) 34 (15) Dead on arrival 10 (14) 18 (8) Note: Some figures are rounded down Using the WHO (2008) definition of potentially The vast majority of calls for assistance were made preventable or preventable (based on an estimated by someone directly involved in the incident, a probability of survival of 25 to 50 per cent and bystander or a passer-by (93 per cent in Cheshire greater than 50 per cent, respectively), 45 per cent and 86 per cent in Manchester (City)). of Cheshire deaths and 59 per cent of Manchester (City) deaths were potentially preventable or Excluding those found dead, a first aid intervention preventable. was attempted in 43 per cent of the remaining cases in Cheshire and 57 per cent in Manchester Bystander presence (City). Information on the presence of a bystander, and Types of intervention which might help how the call for assistance was made, allows for speculation around the moments after injury and Given the high incidence of traumatic brain injury, the possibility for first aid intervention. A bystander the current study places greater emphasis on was on the scene during or immediately after the the need to provide ventilatory intervention when point of injury in 45 per cent of deaths (n = 60) in a head injury has occurred, particularly due to Cheshire and 43 per cent (n = 19) in Manchester the subsequent physiological response to brain 10 (City). A passer-by was on the scene within injury, known as impact brain apnoea. If the airway minutes in an additional 7 per cent (n = 9) of cases is supported during this time, then death from in Cheshire and 5 per cent (n = 4) in Manchester prolonged apnoea may be avoided (Wilson et al. (City). Furthermore, a bystander or passer-by was 2016). on the scene prior to the emergency services in 96 per cent of Cheshire deaths and 86 per cent of Oliver et al. (2016) go on to note that traumatic Manchester (City) deaths. brain injury is the commonest mode of death following traumatic injury and that the critical In Cheshire, the mean average time taken for the phase of a head injury takes place in the first emergency services to arrive after call-out was 10 minutes, although they also note that this is an 11 8.4 minutes (median 6.5 minutes). In Manchester arbitrary time reference (Atkinson 2000). (City) the average time was 8.1 minutes (median 7 minutes).12 10 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. 11 Based on data from 50 records. 12 Based on data from 36 records.