Epidemiology of Prehospital and Hospital Traumatic Deaths from Life-Threatening Hemorrhage

The health burden of injury on our society is substantial, and injury remains the leading cause of death in the United States, accounting for 59% of deaths up to age 45. The majority of injury mortality occurs before hospital arrival, with 62% of civilian and 87% of military traumatic deaths reported to occur prehospital. The concept of analyzing mortality after injury along a chronologic access was introduced in Dr. Trunkey’s seminal work describing the trimodal distribution of trauma deaths in immediate, early, and late timeframes after injury. “Immediate” deaths after trauma occur within less than 1 hour and are best addressed through trauma system development that includes prevention and safety interventions. “Early” deaths are most commonly attributed to massive bleeding and severe central nervous system injuries; the interval between injury and bleeding control has been identified as the key factor in survival for this group of severely injured patients. Trauma system development and injury care has focused intensely on early resuscitation and control of bleeding, largely through increased emphasis on prehospital care and rapid transport to designated trauma centers. The “late” timeframe of death after injury corresponds to patients who die days or weeks after injury usually due to infection, multiple organ failure, or devastating brain injury. About one-fourth of trauma deaths may be potentially preventable. Interventions dedicated to advanced bleeding control and hemostatic resuscitation in the field early after injury in tactical and austere environments have the greatest potential to improve survival after injury.