University of Arizona Initiative Doubles Survival Rates After Severe Traumatic Brain Injury

The University of Arizona recently released the results of an important study to the media with the headline, “UA-Led Initiative Doubles Survival Rates After Severe Traumatic Brain Injury“. Dr. Dan Spaite, Chair of Emergency Medicine at the UA was the lead author on the study which was published May 8 in JAMA Surgery: The Journal of the American Medical Association.

The study looked at the success of the Excellence in Pre-hospital Injury Care Project, or EPIC. The initiative was led by the University of Arizona, the Arizona Department of Health Services and more than 130 fire departments and pre-hospital EMS agencies across the state. They compared the results from those using the new guidelines to the results of those not using the guidelines.

The project was funded by a $3.6 million grant (NS071049) from the National Institute of Neurological Disorders and Stroke, part of the National Institutes of Health.

They trained more than 11,000 paramedics and EMTs in a new treatment protocol for patients who have a Traumatic Brain Injury or TBI. When the EPIC protocol was applied, the survival rate of severe TBI victims doubled. The survival rate tripled among TBI victims who were also intubated. These are astonishing results.

EPIC is the first major pre-hospital interventional project to evaluate the impact of new TBI treatment guidelines that contradicted decades of widely practiced treatment protocol.

The findings have huge implications for field treatment of severe TBI. Implementation of this new protocol nationally could save many lives.

Under EPIC, first responders are taught to treat and prevent the “Three H-bombs”, hyperventilation, hypoxia and hypotension.

Prior to the implementation of EPIC, first responders were taught to hyperventilate TBI patients with a BVM. This was thought to reduce intracranial pressure and improve survivability. Recent research shows that while hyperventilation reduces intracranial pressure it also deprives the brain of blood and oxygen by constricting blood vessels.

First responders tend to ventilate too fast, leading to hyperventilation. The solution they implemented was simple, using a timing light on the BVM.

The second “H-Bomb” is hypotension. So initiating an IV early is critical.

The last “H-Bomb” is hypoxia. To prevent this, first responders are taught to use high-flow oxygen as soon as possible.

While similar guidelines have been widely used in acute care, this is the first large-scale study that looked specifically at the results of their implementation in the field.

For the complete paper see

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About Dan White

I'm a retired Paramedic and EMS Instructor with 35 years EMS and emergency medical product experience. I love canoes, cars and EMS. I have written a lot about EMS Technology on the Paramedic Blog, the Insights on Innovation column for, on and I can be reached directly at 573-240-0002.
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