Trained lay first responders reduce trauma mortality: a controlled study of rural trauma in Iraq.

INTRODUCTION Recent studies demonstrate that early, in-field, basic life support by paramedics improves trauma survival where prehospital transport times are long. So far, no case-control studies of the effect of layperson trauma first responders have been reported. It was hypothesized that trained layperson first responders improve trauma outcomes where prehospital transit times are long. METHODS A rural prehospital trauma system was established in the mine and war zones in Iraq, consisting of 135 paramedics and 7,000 layperson trauma first responders in the villages. In a non-randomized clinical study, the outcomes of patients initially managed in-field by first-responders were compared to patients not receiving first-responder support. RESULTS The mortality rate was significantly lower among patients initially managed in-field by first responders (n=325) compared to patients without first-responder support (n=1,016), 9.8%; versus 15.6%;, 95%; CI=1.3-10.0%;. CONCLUSIONS Trained layperson first responders improve trauma outcomes where prehospital evacuation times are long. This finding demonstrates that simple interventions done early-by any type of trained care provider-are crucial for trauma survival. Where the prevalence of severe trauma is high, trauma first-responders should be an integral element of the trauma system.