30 Are prehospital deaths from trauma and accidental injury preventable? A summary report The therapeutic vacuum occupies the prehospital study one found that 43.3 per cent of people had space between the emergency occurring and a probability of survival greater than 50 per cent, professional help being provided. Without the compared to 39.5 per cent in the 1994 study. development of indicators to measure activity When the more recent analysis method was used during this period, there remains a perception of to calculate the probability of survival, study two the inevitability of death in this space and a lack of found that between 45 per cent and 59 per cent of a clear definition of what is meant by prevention in deaths were potentially preventable or preventable the prehospital space (ibid.). according to WHO definitions (2008). The percentage of potentially preventable or The nature and cause of death preventable deaths remains high and unchanged since 1994 and, although calls for assistance All studies, including the 1994 original, had a were made in up to 93 per cent of cases, first aid comparable sample in relation to gender; however, intervention of any kind was infrequent. age at death from injury had increased to the same average age observed in other research (see A bystander or passer-by was on the scene Kehoe et al. 2015). during, immediately after or in the minutes after the point of injury in up to 52 per cent of cases. Both studies showed that the mechanism of injury However, when those found dead are excluded, has also changed, in line with trends observed a first aid intervention was attempted in between in other studies. The number of deaths from falls 43 and 57 per cent of cases. This is despite the increased, whereas the number of road deaths injured potentially being alive at this stage. This decreased. However, the proportion of car presents an opportunity to help, but is often a occupants and pedestrians dying from injuries missed opportunity. sustained on the road remained comparable to the 1994 study, which suggests that the vulnerability The authors of the studies had only the coroners’ of the driver in particular remains high. records from which to collect data and did not examine the role of the emergency call handlers Although outside the scope of this research, in supporting people who have dialled 999 to there was a significant increase in the number perform first aid. Therefore, no assumption can be of hangings observed compared to the 1994 made as to the content of these telephone calls; study. UK suicide rates have fluctuated over the however, an exploration of these conversations past 30 years. According to the ONS (2016a), in would be an interesting route for future research. 2010 the rate was 10.2 per 100,000 population, compared to 13.2 in 1990. However, the The interventions which the authors suggest could proportion of suicides in the UK from hanging, be beneficial during the therapeutic vacuum are strangulation and suffocation has increased. supporting the airway and controlling bleeding. Between 2002 and 2012, this proportion rose This aligns with the skills that members of the from 45 per cent to 58 per cent for men, and public wish to learn. In an online survey of 1,035 from 26 per cent to 36 per cent for women. It individuals who were interested in learning first aid was not the intention of the current studies to but had neither attended a course in the last year explore suicide or the variables that might explain nor worked in a place where they were required its incidence, such as location, personal factors to have first aid training, the top five emergencies and demography. However, there is room for they wanted to be taught the skills to respond future research to examine the apparent increase to were: heart attack, unconscious and not found in this study and what factors might have breathing, unconscious and breathing, bleeding influenced this trend. heavily, and choking (adult) (Flood and Campbell 2014). Preventability of death In practice, therefore, there is a need to turn those interested in first aid into those who attend training It is clear that little has changed in terms of the and then act in an emergency. The key issue is percentage of people whose death may have been how to motivate people to learn and act. preventable, although the mechanism of injury has changed. Our knowledge of the bystander effect helps us understand why people do or do not act in an When compared to the 1994 study findings, using emergency. This phenomenon has received much the same historic analysis for probability of survival, research attention and, as such, has resulted in