A prospective three-year study from Eylam Province in Iran. Rural trauma systems reduce trauma mortality and morbidity

A previous survey reported high mortality rates in land mine accidents in Eylam, Iran (36%) (REF 1). Responding to the survey, the actual intervention aimed at reducing land mine mortality by setting up a rural trauma system in land mine infested areas of Eylam. Method: An intervention study of prehospital and emergency trauma care was carried out. Health personnel at rural clinics and layman villagers were trained and equipped for trauma care. Prehospital medical data were gathered on all consecutively injured from 2002 to 2004 (n = 641).Outcome indicators (treatment impact on physiological severity, and trauma mortality) were gathered at one referral surgical center. Results: In the rural clinics 109 health workers had training in advanced life support procedures including practice on animal models. At village level 4,725 lay people were trained in basic life support and as first helpers. The system managed 473 casualties with penetrating injuries and 168 patients with blunt injuries. The median ISS of the study population was 9, there were 144 (22.5%) major trauma victims (ISS >15). The overall mortality in the three year study period was 10.4%. Of 177 land mine casualties, 37 died (20.9%). The physiological condition in-field PSS=6.409 as compared to hospital admission PSS=7.505 was significantly improved in most trauma victims (95%CI of difference in physiological severity -1.2278 – - 0.9641). Conclusion: Low-tech and low-cost prehospital trauma programs improve trauma care in rural Iran. Compared to historical control, the intervention significantly reduced mortality rates also in land mine victims%15 (95%CI for difference %8.8 to %22).