Haemorrhagic shock is a significant contributor to early preventable trauma deaths and necessitates urgent intervention. Despite the critical importance of prehospital care in trauma systems, the identification and management of shock in this setting remain challenging. This study aims to identify factors associated with shock following major trauma.
We performed a registry based cohort study using the VSTR between January 1 2010, to December 31 2020. Data were linked to the Ambulance Victoria VACIS database, as well as Computer aided dispatch data. We included all major trauma patients, transported by Ambulance, who were injured within 70km of the MTS.
Over the 10 year period, 16,265 major trauma patients were identified, and transported to a metropolitan ED. 26% of patients presented with shock, and of this, 88% of the patients were transported by road ambulance. Transport injuries were the leading cause of shock and patients between 10 to 30km from the MTS had an increased odds of shock.
This study highlights that a significant proportion of shocked trauma patients, despite being closer to definitive care, are transported by road ambulance and do not benefit from advanced lifesaving interventions available through helicopter emergency medical services (HEMS). The findings suggest that proximity to trauma centres does not mitigate the risk of shock, underscoring the need for timely and advanced prehospital interventions.
A quarter of major trauma patients develop shock in the prehospital phase, with the majority transported by road. The study underscores the importance of enhancing prehospital care capabilities to improve outcomes for shocked patients.