More Trauma Exposure, Not Just Years on the Job, Improves EMS Clinician Survival Rates

PITTSBURGH – Severely injured patients have a higher chance of survival when initially treated by emergency medical services (EMS) clinicians who handle a large volume of trauma cases, according to latest research from UPMC and the University of Pittsburgh. The study, published today in JAMA Surgery, found that the number of trauma patients treated by an EMS clinician – not just at the agency level – is directly linked to improved patient outcomes.

“EMS clinicians are the entry point into the trauma system,” said Joshua Brown, M.D., M.Sc., UPMC trauma surgeon and Samuel P. Harbison Endowed Assistant Professor of Surgery at the University of Pittsburgh School of Medicine. “Until a patient reaches the hospital, the paramedic or flight nurse is often the only health care provider they have. Unlike in a trauma center, there is no safety net, so it is incredibly important that they be at the top of their game.”

Research Findings

The research builds upon a previous study in the Annals of Surgery, which indicated that EMS agencies with higher trauma volumes demonstrated better patient outcomes. To further investigate this connection, Brown and his team analyzed data from the City of Pittsburgh’s Bureau of EMS and STAT MedEvac, combined with outcomes from the Linking Investigations in Trauma and Emergency Services (LITES) research network.

The team reviewed data from 3,649 severely injured trauma patients treated by 359 EMS clinicians between 2017 and 2021. The results showed that for every five additional patients an EMS clinician treated annually, there was a 10% decrease in the risk of mortality within six hours of the injury.

Surprisingly, the number of years an EMS clinician had worked did not correlate with improved patient survival rates.

“You might assume that someone who’s been a paramedic for 20 years would automatically have better outcomes,” Brown said. “But what we found is that trauma is different. Seeing more trauma patients more often – recognizing those patterns and making those high-stakes decisions – really matters.”

The Importance of Trauma-Specific Experience

Trauma cases often present with complexities like severe bleeding or head injuries, requiring more invasive interventions such as intubation or chest needle decompression. Unlike some medical emergencies where interventions are more standardized, trauma care demands quick, decisive action based on pattern recognition.

“Getting EMS clinicians more exposure to traumas seems to be the key, but we can’t just close EMS agencies and concentrate all the experience in one place – that would lead to longer wait times and worse outcomes,” Brown explained. “We require different solutions.”

Potential Strategies for Improvement

The researchers suggest several strategies to enhance EMS performance and save lives:

• Developing national EMS quality benchmarking programs, similar to those used by trauma centers.
• Utilizing artificial intelligence to optimize staffing models and avoid pairing low-volume clinicians together.
• Expanding simulation, virtual reality and other training tools to supplement real-world experience.
• Creating mentorship partnerships between high- and low-volume EMS agencies.

Community Support for EMS

The study emphasizes the importance of community support for EMS systems, which are typically funded through municipal governments. Supporting EMS funding, training, and innovation at the local and policy levels can directly translate into saved lives.

“Supporting EMS funding, training and innovation at the community and policy level is how our findings translate into saved lives,” said Brown.

This research was funded by American College of Surgeons C. James Carrico Faculty Research Fellowship, the LITES Task Order 1 supported by Department of Defense grant W81XWH-16-R-0033 and the U.S. Army Medical Research Acquisition Activity under contract W81XWH-16-D-0024-0001.