Multi-Institutional Multidisciplinary Injury Mortality Investigation in the Civilian Pre-Hospital Environment (MIMIC) 

Brian Eastridge, MD FACS

This project involves a review of 3,000 pre-hospital deaths in six areas of the country to develop a more comprehensive understanding of the epidemiology of pre-hospital deaths and their potential survivability with the ultimate goal of identifying liabilities in our current trauma system and improving survival of both civilian and military casualties. The work is organized around five technical objectives:

Objective #1: Develop a framework and methodology for evaluating (i) the causes and pathophysiologic mechanisms of pre-hospital deaths; (ii) the appropriateness of EMS response and care delivered; and (iii) the potential for survivability under both optimal clinical circumstances and within the context of each individual injury event.

Objective #2:  Organize and standardize a multidisciplinary, multi-institutional network of experts who will apply the methodology described above to identify the causes of pre-hospital deaths due to trauma and estimate the potential for survivability.  The requisite network will be composed of relevant disciplines including trauma surgery, neurosurgery, orthopedic surgery, forensic pathology, radiology and emergency medicine with a specialization in emergency medical services.

Objective #3: Using the methodology and network of experts described above, define the causes and pathophysiologic mechanisms of 3,000 pre-hospital deaths occurring in six regions of the country, and estimate the potential for survivability by mechanism of injury (e.g., blunt versus penetrating), geographic location of the injury (urban, suburban, rural, wilderness), the maturity of the local trauma system, and age of the decedent.

Objective #4:  Describe the epidemiology of pre-hospital mortality in the context of trauma system development and estimate its impact on society.

Objective #5:  Develop a blueprint for a sustained effort at public health injury mitigation strategies in the pre-hospital environment, identifying high priority areas for injury prevention, trauma systems performance improvement as well as opportunities for advancements in research and development.