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Potential survivability of prehospital injury deaths in New Zealand: a cross-sectional study
  1. Bridget Kool1,
  2. Rebbecca Lilley2,
  3. Gabrielle Davie2,
  4. Brandon de Graaf2,
  5. Pararangi Reid3,
  6. Charles Branas4,
  7. Ian Civil5,
  8. Bridget Dicker6,
  9. Shanthi N Ameratunga7
  1. 1Section of Epidemiology and Biostatistics, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
  2. 2Injury Prevention Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
  3. 3Te Kupenga Hauora Maori, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
  4. 4Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
  5. 5Department of Surgery, School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
  6. 6Paramedicine Department, School of Clinical Sciences, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
  7. 7Population Health Directorate, Counties Manukau Health, Auckland, New Zealand
  1. Correspondence to Dr Bridget Kool, The University of Auckland, Auckland 1142, New Zealand; b.kool{at}


Introduction Acknowledging a notable gap in available evidence, this study aimed to assess the survivability of prehospital injury deaths in New Zealand.

Methods A cross-sectional review of prehospital injury death postmortems (PM) undertaken during 2009–2012. Deaths without physical injuries (eg, drownings, suffocations, poisonings), where there was an incomplete body, or insufficient information in the PM, were excluded. Documented injuries were scored using the AIS and an ISS derived. Cases were classified as survivable (ISS <25), potentially survivable (ISS 25–49) and non-survivable (ISS >49).

Results Of the 1796 cases able to be ISS scored, 11% (n=193) had injuries classified as survivable, 28% (n=501) potentially survivable and 61% (n=1102) non-survivable. There were significant differences in survivability by age (p=0.017) and intent (p<0.0001). No difference in survivability was observed by sex, ethnicity, day of week, seasonality or distance to advanced-level hospital care. ‘Non-survivable’ injuries occurred more commonly among those with multiple injuries, transport-related injuries and aged 15–29 year. The majority of ‘survivable’ cases were deceased when found. Among those alive when found, around half had received either emergency medical services (EMS) or bystander care. One in five survivable cases were classified as having delays in receiving care.

Discussion In New Zealand, the majority of injured people who die before reaching hospital do so from non-survivable injuries. More than one third have either survivable or potentially survivable injuries, suggesting an increased need for appropriate bystander first aid, timeliness of EMS care and access to advanced-level hospital care.

  • trauma systems
  • prehospital
  • mortality

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  • Funding This study was funded by the Health Research Council of New Zealand (15/186).

  • Competing interests None declared.

  • Patient and public involvement The study was supported by a study advisory group which provided input into the design and conduct of the research. This study advisory group met on a regular basis for the duration of the study and included representatives from health care providers, the Accident Compensation Corporation, Maori and Pacific consumer health groups, the Ministry of Health, and emergency medical service providers. At the end of the study, the study advisory group commented on the findings and contributed to the dissemination plan

  • Patient consent for publication Not required.

  • Ethics approval The New Zealand Health and Disability Ethics Committee (Reference: OTA/99/02/008/AM05) and the University of Auckland Human Participants Ethics Committee (Reference: 016179).

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

  • Data availability statement Data may be obtained from a third party and are not publicly available.