A traumatic tale of two cities: does EMS level of care and transportation model affect survival in patients with trauma at level 1 trauma centres in two neighbouring Canadian provinces?

Emerg Med J. 2018 Feb;35(2):83-88. doi: 10.1136/emermed-2016-206329. Epub 2017 Nov 4.


Background: Two distinct Emergency Medical Services (EMS) systems exist in Atlantic Canada. Nova Scotia operates an Advanced Emergency Medical System (AEMS) and New Brunswick operates a Basic Emergency Medical System (BEMS). We sought to determine if survival rates differed between the two systems.

Methods: This study examined patients with trauma who were transported directly to a level 1 trauma centre in New Brunswick or Nova Scotia between 1 April 2011 and 31 March 2013. Data were extracted from the respective provincial trauma registries; the lowest common Injury Severity Score (ISS) collected by both registries was ISS≥13. Survival to hospital and survival to discharge or 30 days were the primary endpoints. A separate analysis was performed on severely injured patients. Hypothesis testing was conducted using Fisher's exact test and the Student's t-test.

Results: 101 cases met inclusion criteria in New Brunswick and were compared with 251 cases in Nova Scotia. Overall mortality was low with 93% of patients surviving to hospital and 80% of patients surviving to discharge or 30 days. There was no difference in survival to hospital between the AEMS (232/251, 92%) and BEMS (97/101, 96%; OR 1.98, 95% CI 0.66 to 5.99; p=0.34) groups. Furthermore, when comparing patients with more severe injuries (ISS>24) there was no significant difference in survival (71/80, 89% vs 31/33, 94%; OR 1.96, 95% CI 0.40 to 9.63; p=0.50).

Conclusion: Overall survival to hospital was the same between advanced and basic Canadian EMS systems. As numbers included are low, individual case benefit cannot be excluded.

Keywords: emergency care systems, advanced practitioner; emergency care systems, primary care; prehospital care; trauma.

Publication types

  • Observational Study

MeSH terms

  • Adult
  • Aged
  • Cohort Studies
  • Emergency Medical Services / methods*
  • Emergency Medical Services / standards
  • Female
  • Humans
  • Logistic Models
  • Male
  • Middle Aged
  • New Brunswick
  • Nova Scotia
  • Retrospective Studies
  • Survival Analysis
  • Transportation of Patients / methods
  • Transportation of Patients / standards*
  • Transportation of Patients / statistics & numerical data
  • Trauma Centers / organization & administration
  • Trauma Centers / statistics & numerical data
  • Wounds and Injuries / therapy*