Injury Severity Score alone predicts mortality when compared to EMS scene time and transport time for motor vehicle trauma patients who arrive alive to hospital

ABSTRACT

Objective: This study aims to identify the association, if any, between prehospital scene time, prehospital transport time, and Injury Severity Score (ISS) with in-hospital mortality.

Methods: A retrospective analysis was performed on patients at least 18 years of age who arrived to the hospital alive via emergency medical services (EMS) after a motor vehicle collision (MVC) between 1992 and 2016. These patients were divided into groups based on minutes spent at the scene and in transport. The ISS of the in-hospital mortalities, as well as the entire patient sample for each time frame, was collected. Patients without documented scene time, transport time, or ISS were excluded.

Results: Four thousand one hundred ninety-four patients were captured when analyzing scene time, though only 3,980 met inclusion criteria. In addition, 4,177 patients were captured when analyzing transport time, though only 3,979 met inclusion criteria. Scene time and transport time were not statistically significant predictors of in-hospital mortality (P = .31 and P = .458, respectively). ISS was found to be a statistically significant predictor of in-hospital mortality (P < .001).

Conclusions: ISS predicts mortality independent of scene time or transport time for patients who arrive to the hospital alive following an MVC at Guthrie Robert Packer Hospital. Limitations of our study include inability to capture prehospital deaths and inability to correlate ISS with prehospital injury severity scores.     

Experimental design of the Svalbard shoreline field trials

Experimental oil spills on three mixed-sediment beaches in Svalbard, Norway, were designed to evaluate the effectiveness of in situ shoreline cleaning treatments to accelerate natural recovery. These were: sediment relocation (surf washing), mixing (tilling), bioremediation (fertilizer application), and bioremediation combined with mixing. Additionally, natural attenuation was studied as a treatment option. An intermediate fuel oil was applied to the sediment surface in the upper intertidal zone at three experimental sites, each of which had different sediment characteristics and wave-energy exposure. Over a 400-day period, the experiments quantified oil removal, documented changes in the physical character of the beach as well as oil fate and behaviour, assessed toxicity effects associated with treatment, and validated oil-mineral aggregate formation as a result of the selected treatment techniques. The three sites were chosen based on significant differences, and each treatment was quantitatively compared only with other treatments at that site.This paper describes the physical location and the experimental design of the field trials. Some of the key issues that were addressed in the design included: the methodology for application of oil, the application of treatment techniques, the realistic simulation of real-world conditions, and the sampling protocols to overcome sediment and oiling heterogeneity typical of mixed-sediment beaches in order to allow quantitative comparisons of the treatments.     

In-situ Treatment of Oiled Sediment Shorelines

Experimental oil spill studies were conducted to quantify the effectiveness of selected in-situ shoreline treatment options to accelerate natural oil removal processes on mixed-sediment (sand and pebble) shorelines. At each of three distinct shoreline sites, treatment test plots and control plots were established within a 40-, 80- and 143-m continuous stretch of oiled shoreline. A total of 5500 l of oil was deposited along a 3-m wide swath in the upper intertidal zone at each site. Approximately one week after oiling, a different treatment technique was applied to each plot. The treatment techniques were: sediment relocation (surf washing), mixing (tilling), bioremediation (fertilizer application), and bioremediation combined with mixing. One plot at each site was monitored for natural attenuation. The quantity of oil removed from the plots was measured six times up to 60 days post-treatment and then again one year later. Changes in the physical character of the beach, oil penetration, movement of oil to the subtidal environment, toxicity, and biodegradation were monitored over the 400-day period.The results verified quantitatively that relocation of oiled sediments significantly accelerated the rate of oil removal from the shoreline by more than one year. Microscopic observations and image analyses confirmed that the oil-mineral aggregate formation process was active and was increased by sediment relocation. Oil biodegradation occurred in this arctic environment, both in the oiled sediments and on the fine mineral particles removed from the sediment by natural physical processes. The biodegradation of oil in sediment was significantly stimulated by simple bioremediation protocols. Mixing (by tilling) did not clearly stimulate oil loss and natural recovery in the context of this experimental design. None of the treatment techniques elevated toxicity in the nearshore environment to unacceptable levels, nor did they result in consequential alongshore or nearshore oiling.     

The Reduction of Stranded Oil by In Situ Shoreline Treatment Options

The Svalbard Shoreline Field Trials quantified the effectiveness of sediment relocation, mixing, bioremediation, bioremediation combined with mixing, and natural attenuation as options for the in situ treatment of oiled mixed-sediment (sand and pebble) shorelines. These treatments were applied to oiled plots located in the upper beach at three experimental sites, each with different sediment character and wave-energy exposure. Systematic monitoring was carried out over a 400-day period to quantify oil removal and to document changes in the physical character of the beach, oil penetration, oil loading, movements of oil to the subtidal environment, biodegradation, toxicity, and to validate oil-mineral aggregate formation.The results of the monitoring confirmed that sediment relocation significantly accelerated the rate of oil removal and reduced oil persistence where oil was stranded on the beach face above the level of normal wave activity. Where the stranded oil was in the zone of wave action, sediment relocation accelerated the short-term (weeks) rate of oil loss from the intertidal sediments.Oil removal rates on a beach treated by mechanical mixing or tilling were not significantly higher than those associated with natural recovery. However there is evidence that mixing/tilling may have enhanced microbial activity for a limited period by increasing the permeability of the sediment.Changes in the chemical composition of the oil demonstrated that biodegradation was significant in this arctic environment and a bioremediation treatment protocol based on nutrient enrichment effectively doubled the rate of biodegradation. However, on an operational scale, the success of this treatment strategy was limited as physical processes were more important in causing oil loss from the beaches than biodegradation, even where this oil loss was stimulated by the bioremediation protocols.     

The Roles of Photooxidation and Biodegradation in Long-term Weathering of Crude and Heavy Fuel Oils

Although spilled oil is subject to a range of natural processes, only combustion, photooxidation and biodegradation destroy hydrocarbons and remove them from the biosphere. We present laboratory data that demonstrate the molecular preferences of these processes, and then examine some oil residues collected from previously documented releases to confirm the important roles that these processes play in removing spilled oil from both marine and terrestrial environments.     

Oil-Mineral Aggregate Formation on Oiled Beaches: Natural Attenuation and Sediment Relocation

The significance of oil-mineral aggregate (OMA) formation on the effectiveness of the in situ shoreline treatment options of natural attenuation (natural recovery) and sediment relocation (surf washing) was examined during field trials on two mixed-sediment (sand and pebble) beaches experimentally oiled with IF-30 oil. At both sites, the amount of oil remaining in the experimental plots was dramatically reduced within five days after sediment relocation treatments. Time-series microscopy and image analysis of breaker-zone water samples demonstrate that OMA formation occurred naturally on the oiled beaches at both sites and was accelerated by the sediment relocation procedure. Lower concentrations of OMA in the breaker zone at Site 3 are attributed to the higher wave-energy levels at this site that presumably facilitated more rapid OMA dispersion. The granulometry and mineralogy of beach sediment and of subtidal sediment trap samples indicate that the material settling in nearshore waters originated from the relocated sediment and that a portion of the finer sediment was probably transported out of the study region before settling. Gas chromatography/mass spectrometry analysis demonstrated that a significant fraction of the oil dispersed into nearshore waters and sediments by interaction with mineral fines was biodegraded. The fact that little or no residual oil was found stranded on the shore in areas adjacent to the experimental plots and that only small amounts of oil were found in nearshore subtidal sediments and sediment trap samples suggests that a large fraction of the oil lost from the experimental plots may have been dispersed in the form of relatively buoyant OMA.     

Bioremediation of Stranded Oil on an Arctic Shoreline

The application of slow-release and soluble fertilizers proved to be an effective and environmentally benign way of stimulating oil biodegradation on an Arctic shoreline. Fertilizer application to the surface of the beach delivered nutrients to the oiled sediment beneath the beach surface. There was no significant run-off of this fertilizer to either the nearshore water or to unfertilized plots, and there were no adverse toxicological effects of the fertilizer application. The fertilizer application was followed by an increase in oxygen consumption and carbon dioxide evolution from the beach, increased microbial biomass, and significantly greater biodegradation of oil on the plots that had received fertilizer. The rate of oil biodegradation was approximately doubled over the course of a year by fertilizer applications in the first two months after the spill.Simple test kits proved adequate to monitor the fertilizer-application process in the field in a time frame that would allow the application process to be fine-tuned during treatment on a real spill. Simple test kits and portable instrumentation were useful in demonstrating the initial success of the bioremediation strategy.