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Evaluating the impact of prehospital care on mortality following major trauma in New Zealand: a retrospective cohort study
  1. Bridget Kool1,
  2. Rebbecca Lilley2,
  3. Gabrielle Davie2,
  4. Papaarangi Reid3,
  5. Ian Civil4,
  6. Charles Branas5,
  7. Brandon de Graaf2,
  8. Bridget Dicker6,7,
  9. Shanthi N Ameratunga1,8
  1. 1 Section of Epidemiology and Biostatistics, School of Population Health, The University of Auckland, Auckland, New Zealand
  2. 2 Injury Prevention Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
  3. 3 Te Kupenga Hauora Māori, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
  4. 4 Trauma Services, Auckland District Health Board, Auckland, New Zealand
  5. 5 Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA
  6. 6 Department of Paramedicine, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
  7. 7 St John, Mt Wellington, Auckland, New Zealand
  8. 8 Population Health Directorate, Counties Manukau District Health Board, Auckland, New Zealand
  1. Correspondence to Dr Bridget Kool, The University of Auckland Faculty of Medical and Health Sciences, Auckland 1050, New Zealand; b.kool{at}


Background Injury is a leading cause of death and health loss in New Zealand and internationally. The potentially fatal or severe consequences of many injuries can be reduced through an optimally structured prehospital trauma care system that can provide timely and appropriate care.

Objective To investigate the relationship between emergency medical services (EMS) care and survival to hospital for major trauma cases in New Zealand.

Methods This project is a retrospective cohort study of New Zealand major trauma cases attended by EMS providers over a 2-year period. Outcomes include survival to hospital and survival in hospital for at least 24 hours. The project has three phases: (1) identification of the cohort and assembling a bespoke longitudinal dataset linking EMS, New Zealand Major Trauma Registry and Coronial data; (2) describing the pathways and processes of care to inform an investigation of the relationships between types of EMS care and survival using propensity score modelling to adjust for case-mix differences; (3) assessment of the implications for future practice, policy and research.

Discussion The study findings will help identify opportunities to optimise the delivery of EMS care in New Zealand by informing the development or revision of existing major trauma EMS policies and guidelines, and to provide a baseline for monitoring the impact of future initiatives. Establishing an evidence-base will support a whole-of-system appraisal that could include broader complex variables relating to healthcare services throughout the continuum of trauma care.

  • prehospital
  • trauma systems
  • cohort study
  • descriptive epidemiology

Data availability statement

Data sharing not applicable as this is a study protocol and no data sets have been generated or analysed.

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Data availability statement

Data sharing not applicable as this is a study protocol and no data sets have been generated or analysed.

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  • Correction notice The article has been corrected since it is published. The name of the 4th author has been

    corrected to Papaarangi Reid.

  • Contributors BK was the lead author and is guarantor of this paper. Study investigators (RL, GD, PR, IC, CB, BdG, BD, SNA) had overall responsibility for the conception of the study. All authors contributed to the writing of this paper and BK drafted the paper. All authors contributed to the funding application, the study design and the review and editing of the manuscript. All authors approved the submitted manuscript.

  • Funding This project is funded by a Health Research Council of New Zealand project grant (HRC 18/465).

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.