Specific shock injury severity in victims of road accidents occurring on the M-8 Kholmogory federal highway in the Arkhangelsk region

Relevance . In the Russian Federation, road accidents are still among the top major causes of emergencies. Shock-associated injuries are of special consideration due to their health consequences. The type and scope of injury-associated shock depends on the cause of the accident, time of year, injury type and severity, thus determining the approaches and strategy in emergency medical care of victims at the pre-hospital and subsequent stages of treatment. The objective is to analyze the shock injuries resulting from road accidents occurring on the M-8 Kholmogory federal highway in the Arkhangelsk region in order to analyze the causes, severity and type of trauma injuries and eventually improve the emergency medical care provided to the injured at the pre-hospital stage. Methodology . The study analyzed medical records from 49 patients presented with a shock injury following an accident on the M-8 Kholmogory highway and admitted to the Arkhangelsk Regional Clinical Hospital – a first-tier multidisciplinary hospital and trauma center. The classification by A.V. Kaplan et al. was applied to identify the injury type; the injury severity was evaluated using the ISS score; the criteria suggested by E.K. Gumanenko et al. were applied to split combined injuries into severe combined injuries, polytrauma and extremely severe polytrauma. The STATA ver. 12 program was used for statistical analysis of the data obtained. Results and discussion . The causes of shock injuries in the victims of road accidents on the M-8 Kholmogory highway include vehicle collisions (63.2%), pedestrian injuries (20.5 %) and vehicle rollover (16.3 %). Notably, over 50 % of all shock injury-associated accidents in winter. The patients presented with combined injuries (90 %), including the utmostly severe injuries – polytrauma (55.1%) and extremely severe polytrauma (12.2 %). Conclusion . Considering that most severe shock injuries caused by road accidents occurred during the winter season, ambulances require specific personal heating equipment to warm the injured – hypothermia evacuation bags with an independent electric heating system and thermal blankets order to mitigate convective heat loss from patients. In addition, an independent blood and IV fluid warmers should be integrated into the ambulance vehicles, in particular type C mobile ICU ambulances. To optimize the evacuation procedure and minimize the transportation time to specialized emergency centers provided the injured multidisciplinary surgical care, it is essential to set up a network of mobile checkpoints throughout the federal highway.