Germany-wide survey on the prehospital therapy of thoracic trauma

Background: The thorax is one of the most frequently injured regions of the body. Due to the immediate impairment of the cardiopulmonary system, thoracic injuries are a common cause of trauma- associated mortality. We developed a questionnaire to evaluate the prehospital treatment of thoracic trauma in Germany. Methods: We asked 267 regional supervisors of emergency-medical services (EMS) in Germany to invite prehospital emergency physicians within their system to participate in our anonymous online survey. The questionnaire collected data on basic characteristics of the participants, the subjective reliability of prehospital diagnostics and the experience with various invasive procedures (i.e. thoracic drainage, pericardiocentesis and emergency thoracotomy). Results: A total of 487 prehospital emergency physicians completed the survey. They were mostly consultants and senior physicians (73.9%) that worked primarily in hospitals (78.0%) and served 1-4 shifts (70.0%) per month in ground-based EMS (87.7%). Diagnostic difficulties were noted with regard to the reliability of prehospital examination results, which were a common reason (68.3%) to postpone otherwise indicated invasive procedures. Especially with regard to the detection of pericardial tamponade, prehospital point-of-care ultrasound was associated with an increased subjective reliability. Prehospital ultrasound, however, was rarely available (12.7%). Practical experience with invasive procedures, such as thoracic drainage, pericardiocentesis and emergency thoracotomy in the prehospital setting was low. Only 14.3% of the respondents stated that their EMS system was equipped to perform a prehospital emergency thoracotomy. Prior participation in a trauma course was associated with increased confidence in prehospital diagnostics and increased willingness to perform invasive procedures. Conclusions: Major difficulties were noted with regard to the reliability of prehospital diagnostics and the performance of invasive procedures. Particularly in case of traumatic cardiac tamponade, guideline-adherent treatment options do not seem to be available in all EMS systems.