Association between Association between Response time and Response time and

Mortality in Drowning Mortality in Drowning Patients Patients

in Thailandin Thailand Mr.Phichet Nongchang

Dr PH 567110001-5Faculty of Public Health, Khon Kaen University

Drowning is defined as the process of experiencing respiratory impairment from

submersion/immersion in liquid

BACKGROUNDBACKGROUND

BACKGROUNDBACKGROUND• Drowning is a leading cause of accidental death worldwide• Injuries account for nearly 10% of total global mortality. Drowning is the 3rd leading cause of unintentional injury death, accounting for 7% of all injury-related deaths, low- and middle-income countries account for 96% of unintentional drowning deaths(WHO)

BACKGROUNDBACKGROUND

• In Thailand 2008, drowning was the second cause of death in injuries (4,065 cases)• Emergency medical services (EMS) • Response time effected improving patient outcomes. • It is not yet clear for Thailand

To determine association between response times and mortality in drowning patientsin Thailand

OBJECTIVEOBJECTIVE

MATERIALS AND METHODS

• Cross sectional analytical • Thailand EMS database.•National Institute for Emergency Medicine (NIEM)•Across country (except Bangkok)•2011-2012

Study Outcome

The primary outcome:•mortality of drowning on emergent patients (out-of-hospital)

Independent variables:•response time •Scene time, Transport time•CPR, Gender, Age, Region

Statistical Analysis

• Statistical analysis by Stata version 12.0

• Descriptive statistics (frequency and percentage)

• multiple logistic regression Odds Ratios, 95%

Confidence Intervals, and p-value.

RESOULTRESOULT

Exclude with other case (435,723)

Excluded with Urgent, Non-urgent and other (792)

Demographic CharacteristicsDemographic Characteristics

Demographic CharacteristicsDemographic Characteristics

Demographic CharacteristicsDemographic Characteristics

Demographic Characteristics Demographic Characteristics

Characteristic N %Response times (Mean: SD)

1,23814.0: 16.8

Scene times(Mean: SD)

1,058 9.7: 19.8

Transport times(Mean: SD)

1,18211.3: 10.8

Death on drowning (Out-of-hospital) 1,243 13.8

Factor   OR adj

95%CI P-value

Response times   1.01 0.99 - 1.03

0.255

Scene times   1.01 1.01 - 1.02

0.001

Transport times  1.03

0.99 - 1.07

0.169

Gender         Female   1   0.575 Male   1.23 0.60 -

2.51 

Age         Less or equal 12

  1 

0.014

13 - 24   0.39 0.11 - 1.32

 

25 - 36   1.41 0.56 - 3.46

 

37 – 48   1.19 0.52 - 2.71

 

49 – 54   0.87 0.20 - 3.72

 

55 – 66   1.70 0.68 - 4.26

 

67 or greater   0.92 0.19 - 4.44

 

Region        South   1   0.008

East   0.64 0.15 - 2.69

 

North   0.45 0.07 - 2.73

 

Northeast   1.67 0.53 - 5.24

 

Central   3.06 0.94 - 9.98

 

CPR         No   1    

Yes 

4.532.36 -

8.71<0.001

1 2 3 4 5 6 7 8 9 10

0 0.5

DISSCUSSIONDISSCUSSION

• This study did not show significant increase in mortality of drowning patients form increase response times• OR adj = 1.01 • 95 % CI (0.99 - 1.03) P-value=0.255

DISSCUSSIONDISSCUSSION

• Response times association survival in out-of-hospital cardiac arrest (OHCA) by drowning• Response times affected patient mortality and associated with higher mortality rates• response times no associated mortality with in Acute Heart Failure Patients

DISSCUSSIONDISSCUSSION

• Did not demonstrated association between scene time and transport times and mortality• Transportation time correlate with mortality in Acute Heart Failure Patients• No association between transport interval and outcome OHCA• Cardiopulmonary resuscitation (CPR)associated mortality in drowning patients

CONCLUSIONSCONCLUSIONS

• The study could not demonstrate that Response times association

mortality in emergent drowning

Patients in Thailand• Further study should be

conducted to the pre-hospital factors effect survival of drowning, and the effectiveness of CPR for drowning survival

THANK YOUTHANK YOUfor your attentionfor your attention

THANK YOUTHANK YOUfor your attentionfor your attention