In a recent article in the Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine by Pakkanen et al, retrospective data from a Finnish prehospital service is presented. They looked at prehospital management of severe TBI (severe head injury with GCS 8 or lower) over a 6-year period, including some 458 patients for analysis. They found a significantly higher 1-year mortality in the non-physician group compared with the group where a doctor was involved in the EMS response (57 % vs. 42 %). There was also a tendency toward better neurological outcomes among survivors in the physician-staffed cohort.

One very clear difference between the two groups in patient management was the use of advanced prehospital airway management (98% when doctor present vs. 16% when not). This may at least partly explain the difference in outcomes. Hypoxia seemed to be more common the the paramedic-group, whilst the groups were comparable with regards to other vital signs. In Finland, like in most Scandinavian countries, prehospital airway management is largely performed by physicians. Thus there are clearly vastly different airway approaches being applied, depending on whether there is a prehospital doctor available.

The study is necessarily hampered by the data being retrospective and the significant risks of bias inherent in that, but the associations are of definite interest and should be studied further in a prospective manner.