Evaluation of the Medical Management and Preventability of Death in 137 Road Traffic Fatalities in Victoria, Australia: An Overview

F. T. McDermott, S. M. Cordner, A. B. Tremayne, Chris Atkin, Afif Hadj, Peter Ryan, Bruce Waxman, Graeme Brazenor, Jeffrey Rosenfel, Michael Murphy, Peter Dorhmann, John Laidlaw, Max Esser, Gary Grossbard, Linas Dziukas, Richard Harrod, Johannes Wenzel, Bill Shearer, Tony Weaver, Graeme DukeJamie Cooper, Peter Morley, David Sell, Greg Cooper, Gordon Trinca, Stephen Cordner, Frank McDermott

Research output: Contribution to journalReview ArticleResearchpeer-review

69 Citations (Scopus)

Abstract

Objectives: In 1992 a multidisciplinary committee was established to identify problems in the management of road fatalities in Victoria, Australia, to assess their contribution to death, and to identify preventable deaths (preventable: survival probability more than 75%; potentially preventable: 25 to 75%). Methods: For 1992 and 1993 all 137 fatality cases surviving until arrival of ambulance services were evaluated by analysis and discussion of their complete prehospital, hospital, and autopsy records. Results: 1,012 problems were identified in 509 admissions to the various areas of care. Six hundred eighty-five (68%) were management errors and 217 (21%) were system inadequacies. Technique errors (45 (4%)), diagnosis delays (25 (2%)), and diagnosis errors (40 (4%)) were less frequent. The emergency department (ED) accounted for 537 (53%) problems, followed by prehospital (200 (20%)) and intensive care unit (118 (12%)). Four hundred seventy (46%) problems were assessed as contributing to death. Two hundred twenty-eight (49%) occurred in the ED, 90 (19%) were prehospital problems, and 63 (13%) occurred in the intensive care unit. Management errors comprised 326 (69%) problems contributing to death, and system inadequacies 88 (19%). Resuscitation problems accounted for 82 (49%) of the 167 ED management errors contributing to death. Eighty-five (62%) deaths were assessed as nonpreventable, 7 (5%) as preventable, and 45 (33%) as potentially preventable. Conclusion: Organizational and educational counter measures are required to reduce the high frequency of problems in emergency services and clinical management.

Original languageEnglish
Pages (from-to)520-533
Number of pages14
JournalThe Journal of Trauma: Injury, Infection, and Critical Care
Volume40
Issue number4
Publication statusPublished - 1 Apr 1996

Keywords

  • Emergency medical services
  • Evaluation studies
  • Hospital mortality
  • Mortality
  • Traffic accidents
  • Trauma severity indices
  • Triage
  • Wounds and injuries

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