Enhancing the tissue donor pool through donation after death in the field.

INTRODUCTION: Tissue transplantation is an important adjunct to modern medical care and is used daily to save or improve patient lives. Tissue allografts include bone, tendon, corneas, heart valves and others. Increasing utilization may lead to tissue shortages, and tissue procurement organizations continue to explore ways to expand the cadaveric donor pool. Currently more than half of all deaths occur outside the acute care setting. HYPOTHESIS: Many who suffer prehospital deaths might be eligible for non-organ tissue donation. METHODS: A retrospective review of electronic prehospital medical records was conducted from May 1, 2008 through December 31, 2009. All prehospital deaths were included irrespective of cause. Once identified, additional medical history was obtained from prehospital, inpatient, and emergency department records. Age, medical history, and time of death were compared to exclusion criteria for four tissue procurement organizations (MTF, LifeNet, LifeCell, EyeBank). After analysis, percentages of eligible donors were calculated. RESULTS: Over 50,000 prehospital records were reviewed; 432 subjects died in the field and were eligible for analysis. Ages ranged from four to 103 years of age; the average was 68.3 (SD = 20.1) years. After exclusion for age, medical conditions, and time of death, 185 unique patients (42.8%) were eligible for donation to at least one of the four tissue procurement organizations (range 11.6%-34.3%). CONCLUSIONS: After prehospital death, many individuals may be eligible for tissue donation. These findings suggest that future prospective studies exploring tissue donation after prehospital death are indicated. These studies should aim to clarify eligibility criteria, create protocols and infrastructure, and explore the ethical implications of expanding tissue donation to include this population.

Use of a limited lights and siren protocol in the prehospital setting vs standard usage.

OBJECTIVE: Our objective was to determine if implementing a standard lights and sirens (L&S) protocol would reduce their use and if this had any effect on patient disposition. METHODS: In a prospective cohort study, we trained emergency medical services (EMS) personnel from 4 towns in an L&S protocol and enrolled control personnel from 4 addition towns that were not using the protocol. We compare the use of L&S between them over a 6-month period. Our protocol restricted the usage of L&S to patients who had maladies requiring expedited transport. Emergency medical services personnel from the control towns had no such restrictions and were not aware that we were tracking their usage of L&S. We also considered if patient disposition was affected by the judicious usage of L&S. RESULTS: Prehospital EMS personnel who were trained in an L&S protocol were 5.6 times less likely to use L&S when compared with those not trained. Of the 808 patients transported by both types of workers, no difference in patient disposition was observed. CONCLUSIONS: Our protocol significantly reduced the use of L&S. Judicious use of L&S has significant implications for transport safety. By allowing for selective transport with L&S usage, we observed no impact in patient disposition.