Date of Award

2012

Degree Type

Thesis

Degree Name

Master of Science

School

School of Medical Sciences

Faculty

Faculty of Computing, Health and Science

First Advisor

Associate Professor Mel Ziman

Second Advisor

Mr Steve Johnston

Third Advisor

Dr Jennifer Thompson

Abstract

There is concern over mortality and the potential for secondary brain injury in the head-injured patient. The use of advanced airway management and rapid sequence intubation in the pre hospital treatment of patients with Traumatic Brain Injury is controversial. Currently in St John Ambulance Service Australia (WA) Inc. three forms of pre hospital treatment are utilized to manage the airway of the adult head-injured patient. If attended by on-road paramedic staff, basic airway management is utilized unless the patient is unconscious and areflexic, in which case advanced airway management utilising endotracheal intubation or laryngeal mask insertion is authorised. In the critical care paramedic setting, the severely head-injured patient can be managed utilising paramedic initiated rapid sequence intubation techniques and ongoing sedation, paralysis and ventilation. There is a lack of data evaluating the risk and outcomes involved with these techniques when utilised to treat head-injured patients by paramedics from the Western Australian ambulance service. This study provides an updated evaluation of outcomes associated with airway management. The research framework was that of a retrospective, observational study of patients transported and treated between January 2004 and January 2009 in Western Australia. As the designated state trauma centre, all major trauma patients admitted to Royal Perth Hospital trauma unit with a head abbreviated injury scale > 3 transported and treated pre hospital by St John Ambulance WA paramedics from January 2004 to January 2009 were included. Hospital records of patient outcomes were matched with pre hospital records. Whilst challenges were faced in the collection of quality, usable data; modifications in analysis methodology allowed achievement of some, but not all objectives. The use of advanced airway management was associated with increased odds of survival (OR of 8.9, p value .046). Results of this study indicate a significant association between advanced airway management practice performed by paramedics and survival for patients suffering TBI. Further research is recommended to accurately assess efficacy of practice of this skill set in the pre hospital environment.

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