Jurnal Internasional vol.12 issue 1 2022
African Journal of Emergency Medicine
Clinical impact of a prehospital trauma shock bundle of care in South Africa

Jurnal Internasional vol.12 issue 1 2022
African Journal of Emergency Medicine
Clinical impact of a prehospital trauma shock bundle of care in South Africa

Prehospital
Emergency medical services
Trauma
Africa
Bundle of care
Shock

Introduction: Patients experiencing traumatic shock are at a higher risk for death and complications. We previ-
ously designed a bundle of emergency medical services traumatic shock care (“EMS-TruShoC”) for prehospital

providers in resource-limited settings. We assess how EMS-TruShoC changes clinical outcomes of critically
injured prehospital patients.
Methods: This is a quasi-experimental educational implementation of a simplified bundle of care using a pre-post
design with a control group. The intervention was delivered to EMS providers in Western Cape, South Africa.
Delta shock index (heart rate divided by systolic blood pressure, reported as change from the scene to facility
arrival) from the 13 months preceding intervention were compared to the 13 months post-implementation. A
difference-in-differences analysis examined the difference in mean shock index change between the groups.
Results: Data were collected from 198 providers who treated 770 severe trauma patients. The patient groups had
similar demographic and clinical characteristics at baseline. Over all time-points, both groups had an increase in
mean delta shock index (worsening shock), with the largest difference occurring 4-months post-implementation
(0.047 change in control arm, 0.004 change in intervention arm; − 0.043 difference-in-differences, P = 0.27). In
pre-specified subgroup analyses, there was a statistically significant improvement in delta shock index in the

intervention arm in patients with penetrating trauma cared for by basic providers immediately post-
implementation (− 0.372 difference-in-differences, P = 0.02).

Discussion: Overall, there was no significant difference in delta shock index between the EMS-TruShoC inter-
vention versus control groups. However, significant improvement in shock index in one subgroup suggests the

intervention may be more likely to benefit penetrating trauma patients and basic providers.

Nee-Kofi Mould-Millman , Julia M. Dixon , Bradley van Ster , Fabio Moreira , Beatrix Bester , Charmaine Cunningham , Shaheem de Vries , Brenda Beaty , Krithika Suresh , Steven G. Schauer , Joseph K. Maddry , Lee A. Wallis , Vikhyat S. Bebarta , Adit A. Ginde

https://doi.org/10.1016/j.afjem.2021.10.003

8 October 2021

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