Background: Blunt implementation of Western trauma system models is not feasible in low-resource communities\r\nwith long prehospital transit times. The aims of the study were to evaluate to which extent a low-cost prehospital\r\ntrauma system reduces trauma deaths where prehospital transit times are long, and to identify specific life support\r\ninterventions that contributed to survival.\r\nMethods: In the study period from 1997 to 2006, 2,788 patients injured by land mines, war, and traffic accidents\r\nwere managed by a chain-of-survival trauma system where non-graduate paramedics were the key care providers.\r\nThe study was conducted with a time-period cohort design.\r\nResults: 37% of the study patients had serious injuries with Injury Severity Score = 9. The mean prehospital\r\ntransport time was 2.5 hours (95% CI 1.9 - 3.2). During the ten-year study period trauma mortality was reduced\r\nfrom 17% (95% CI 15 -19) to 4% (95% CI 3.5 - 5), survival especially improving in major trauma victims. In most\r\npatients with airway problems, in chest injured, and in patients with external hemorrhage, simple life support\r\nmeasures were sufficient to improve physiological severity indicators.\r\nConclusion: In case of long prehospital transit times simple life support measures by paramedics and lay first\r\nresponders reduce trauma mortality in major injuries. Delegating life-saving skills to paramedics and lay people is a\r\nkey factor for efficient prehospital trauma systems in low-resource communities.
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