The speed and skill of emergency medical services (EMS) clinicians can be a matter of life and death for severely injured patients, according to fresh research published today in JAMA Surgery. A study by researchers at UPMC and the University of Pittsburgh found that patients treated by EMS clinicians who regularly handle trauma cases have a significantly higher chance of survival than those seen by clinicians with less frequent exposure to serious injuries. This finding underscores the critical importance of experience in the demanding field of pre-hospital emergency care and highlights the need for innovative strategies to improve EMS performance.
The research, building on previous operate demonstrating the benefits of high-volume trauma centers, focuses specifically on the impact of clinician-level experience. Prior studies showed that EMS agencies serving larger populations with more trauma incidents generally had better patient outcomes. However, this new study drills down to the individual clinician level, revealing that it’s not simply the agency’s overall volume, but the individual provider’s experience with trauma that matters most. The study examined data from nearly 3,700 severely injured patients treated by 359 EMS clinicians in Pittsburgh between 2017 and 2021.
Experience Trumps Tenure in Trauma Care
The key finding is striking: for every five additional trauma patients an EMS clinician treated annually, there was a 10% decrease in the risk of mortality within six hours of the injury. This suggests that frequent exposure to complex trauma cases hones critical decision-making skills and improves the ability to effectively manage life-threatening situations. Interestingly, the number of years a clinician had been working in the field did not correlate with improved survival rates. As senior author Joshua Brown, M.D., M.Sc., a UPMC trauma surgeon and professor at the University of Pittsburgh School of Medicine, explained, “You might assume that someone who’s been a paramedic for 20 years would automatically have better outcomes, but what we found is that trauma is different. Seeing more trauma patients more often – recognizing those patterns and making those high-stakes decisions – really matters.”
Trauma cases present unique challenges for EMS clinicians. Unlike some medical emergencies where interventions are more standardized, trauma often involves complex presentations, severe bleeding, and the need for invasive procedures like intubation or chest decompression. These situations demand rapid assessment, decisive action, and a high level of clinical expertise. The study suggests that consistent exposure to these scenarios is crucial for maintaining and refining those skills.
Addressing the Challenge: How to Increase Trauma Exposure
The researchers acknowledge that simply concentrating all trauma cases in the hands of a few experienced clinicians isn’t a viable solution. Such a strategy would inevitably lead to longer response times and potentially worsen outcomes for patients in less-trafficked areas. Instead, they propose a range of innovative approaches to broaden access to trauma experience for EMS personnel. These include developing national quality benchmarking programs for EMS, similar to those already in place for trauma centers, and utilizing artificial intelligence to optimize staffing models and avoid pairing low-volume clinicians together.
Expanding training opportunities is too a priority. The team suggests increased employ of simulation, virtual reality, and other tools to supplement real-world experience. Establishing mentorship partnerships between high- and low-volume EMS agencies could facilitate knowledge transfer and skill development. UPMC has already demonstrated a commitment to supporting EMS systems, recently donating $10 million to the City of Pittsburgh to purchase new ambulances.
Beyond systemic changes, the researchers emphasize the importance of community support for EMS systems. “Supporting EMS funding, training and innovation at the community and policy level is how our findings translate into saved lives,” Brown said. This includes advocating for adequate resources, promoting professional development opportunities, and recognizing the vital role EMS clinicians play in the healthcare system.
This research builds upon a 2024 study published in the Annals of Surgery, which similarly found that EMS agencies with higher trauma volumes demonstrated improved patient outcomes. The Annals of Surgery study used national data to support this correlation.
The findings have implications for EMS training programs, staffing models, and resource allocation. By prioritizing experience and fostering a culture of continuous learning, EMS systems can further improve their ability to provide life-saving care to those in need. The LITES network, which provided data for this study, continues to investigate ways to improve trauma care outcomes across the country. The next phase of research will focus on identifying specific training interventions that can effectively enhance the skills of EMS clinicians in low-volume areas.
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