Introduction

Deaths from accidents and violence, more commonly called "external causes" (EC), are the third cause of death in the general population and the first one in population aged from one to 39 years, behind cardiovascular disease and cancer, respectively¹⁾⁽².

Violence has assumed worrying role for the Brazilian society in recent decades and has become a serious public health problem because of its magnitude, severity, social impact and ability to make the individual and collective health vulnerable. External causes, which include violence and accidents, are the third cause of mortality in the general population and the sixth cause of hospital admissions in the country³⁾⁽⁴.

In relation to non-fatal events, there are a large number of hospitalizations, emergency services and permanent sequelae, resulting in high costs for society, since most victims are young and in socially productive situation. Absenteeism rates from sequelae resulting from trauma are responsible for the origin of potential pension expenses¹⁾⁽⁵.

The scenarios of emergencies and urgencies care at public services in Brazil may not be prepared or adapted to the current epidemiological transition, to which EX contribute substantially, besides facing many difficulties regarding the structure and the material and human resources. There is a demand for greater State investment for the proper care of victims of trauma, effective public policies that can reduce the alarming rates and, consequently, the associated morbidity and mortality⁶.

Given this issue, the mobile prehospital emergency service plays an important role in the assistance provided to victims of trauma, since this service is characterized by quick response, rescue or transport of patients with declared urgency or emergency conditions⁷.

Most trauma deaths occur in the scene or in the first hour of trauma; however, 76% could be avoided. Agile and quality prehospital care becomes, then, a very important part to ensure the survival of trauma patients. Therefore, the first hour of the initial care to patients in the prehospital phase is referred to as "golden hour"⁸.

Thus, knowing the characteristics that involve trauma is a major factor in the development of operational strategies of multidisciplinary teams in the directed care, the educational and preventive measures to minimize the damage to human life and society.

For this, the following research question arose: How are characterized the traumatic emergencies treated by prehospital emergency service? Thus, this study aimed to describe the epidemiological profile of traumatic emergencies assisted by a mobile prehospital emergency service in Northeastern Brazil.

Material and Method

This is a documentary and descriptive study, with cross-sectional design and quantitative approaches, performed from the records of occurrences assisted between January and June 2014 by the Mobile Emergency Service of Rio Grande do Norte (SAMU 192 RN). The researchers collected the data during the morning and afternoon shifts at the filing sector of SAMU 192 RN, located in the municipality of Macaíba/RN, in the period from May to July 2014.

The study population consisted of the nursing care records of 2,952 occurrences assisted by SAMU 192 RN. The inclusion criteria were records of nursing notes of cases of traumatic emergencies, involving traffic accidents (TA), perforation by firearms (PF), perforation by white weapon (PWW), falls and physical assault by physical force. Exclusion criteria consisted of records of people with medical conditions and records with illegible notes. According to the selection criteria, 992 records were excluded, totaling a sample of 1,960.

Data were collected through a structured questionnaire, which was prepared based on the record of nursing notes of SAMU 192 RN, consisting of the following variables: service data (date, day of week, time, city and type of service), victim information (gender and age) and the gravity of the accident (vital signs, level of consciousness, Glasgow coma scale, types of injuries caused by the accident and injured anatomical segment). For the characterization of the victims, the age was classified in age groups, namely: zero to 24 years = youngster; 25 to 44 years = young adult; 45 to 59 years = adult; 60 years or more = elderly.

Data were analyzed by descriptive statistics, organized in a spreadsheet in Microsoft Excel 2010 software, and then exported to SPSS version 20.0. The results were presented using absolute and relative frequencies in tables.

The research followed the ethical and legal aspects as Resolution No. 196/96 of the National Health Council, supplemented and updated by resolution. 466/12. The study obtained a favorable opinion by the Research Ethics Committee of the University Hospital Onofre Lopes (CEP/HUOL), with protocol number 437/10 and Presentation Certificate to Ethics Assessment (CAAE): 0025.0.294.051-10.

Results

The sample consisted of 1,960 records of services to victims of traumatic emergencies, being 1,327 (67.7%) by TA, 335 (17.1%) from falls, 134 (6.8%) by PF, 93 (4.7%) physical aggression by physical force and 71 (3.6%) by PWW, assisted by SAMU 192 RN between January and June 2014.

Table I shows the characterization of the victims of traumatic emergencies treated by the SAMU 192 RN, according to gender, age and day of the week when the trauma occurred.

According to Table I, most individuals were men (76.2%), classified in the age group of young adults (46.6%) with a mean of 33.9 years (± 19.0), and the largest number of calls for traumatic emergencies was during the weekend, including Saturday and Sunday (37.4%).

As for the association between the gender of victims of traumatic emergencies, and the type of trauma (Table II), men were the most involved in the five types of studied traumatic emergencies. composing 76.2% of the sample, especially by TA (52.7%). TA was the most evident traumatic emergency, followed by falls.

Regarding the association between the type of injury and age group, there was a predominance of young adults (46.6%) individuals between 25 and 44 years, in all types of traumatic emergencies, as shown in Table III.

Table IV explains the association between the Glasgow coma scale and finding polytrauma, or not, in individuals who have suffered some kind of traumatic emergency, during the studied period.

One verified that 58.1% of subjects had a Glasgow Coma Scale between 13 and 15 points, being classified as mild trauma. However, among them, 14.1% suffered polytraumas and 44.0% did not suffer polytraumas. Moreover, there was negligence on the annotation of the Glasgow coma scale in 39.0% of the nursing care records.

Discussion

The trauma can cause temporary and permanent damage, such as death, disability, prolonged and high-cost treatment, causing socioeconomic damage to patients and their families⁹.

A study conducted in 24 Brazilian states and another, in Cuiabá/Mato Grosso/Brazil, found that the most frequent traumatic emergencies were TA, followed by falls, PF, physical assaults by physical force and PWW, which corroborates this study¹⁰⁾⁽¹¹.

TA are considered complex episodes, for they may relate to human error, the vehicle itself and even environmental errors. Some of those factors result from the driver's recklessness, such as risky maneuvers, alcoholism and drugs, excessive speed and fatigue, and may also associate with climatic factors, pathways and inadequate signage and lack of maintenance of vehicles¹².

The Brazilian traffic is considered one of the most dangerous in the world and sets up a public health problem, being subject of serious proportions for modern society, for it is responsible for high rates of morbidity, mortality and disability with physical and/or cognitive permanent sequelae. In Brazil, alcohol consumption associated with driving is identified as one of the main factors responsible for accidents⁵⁾⁽¹³.

Men are most involved in traumatic events. This prevalence may be due to cultural, biological and social factors that promote violent behavior, making them more vulnerable to external causes⁹⁾⁽¹⁴. Research shows that the treatment of women occurred mainly for clinical causes¹¹. Moreover, those events occurred, in greater extent, during the weekend, because of the relationship with festive events, alcohol consumption and decreased supervision¹⁵.

Although men have been the most affected in all categories of traumatic emergencies, one cannot disregard the female victims, for it is a factor that influences health and the social context⁹. In this study, the highest incidence of events among women was the TA. According to the literature, in most TA cases involving women, they were in the passenger seat¹⁴.

Young adults, aged between 34 and 37.6 years, are the main victims of trauma^10)(11)(14. All age groups, except the elderly, suffered mainly TA. It is noteworthy the number of episodes with PF and PWW among youngsters and young adults. Perhaps, violence in this group happens by social inequality and the difficult integration of the youngster in the labor market¹⁶.

Social and cultural determinants related to gender expose men to greater risk for trauma, such as excessive speed, risky maneuvers, violence and alcohol consumption. Nevertheless, this study found that women may be exposed to traumatic situations, although not drinking; they are accompanied by young men who use alcohol, and put their own safety and of those with them at risk¹⁷.

The early age of regular alcohol consumption can leave them more exposed because they are undergoing profound physical and psychological changes, and lead to socially undesirable behavior¹⁷.

Among the elderly, the main cause of injury was falls. People in this age group require great care due to the high mortality rate due to the type of trauma previously mentioned. A research with elderly people living in São Paulo showed that falls from their own height tend to increase the severity according to the increase in age¹⁸.

The Glasgow coma scale assesses the level of awareness and the severity of the injury; therefore, it is of great value in trauma care to estimate the prognosis of the victim¹⁴⁾⁽¹⁹. This scale is also used to evaluate the response-time relationship in the service according to the patient's needs¹⁴.

After a thorough evaluation of the protocol steps for care to the patient with polytrauma and the proper correction of the found lesions, the professional of the emergency service should identify the neurological pattern in which the victim is, and one indicates the use of the Glasgow Coma Scale for this purpose²⁰.

There was negligence of this data in most of the nursing care records, demonstrating the vulnerability of the team to record information, which may indicate possible lack of theoretical knowledge about the proper use of this scale. In turn, professionals associate the decreased level of consciousness with the decrease in the breathing pattern, which, they say, requires the application of the Guedel's cannula²¹.

The participants of the study, as well as in this research, did not properly describe the use of the Glasgow Coma Scale as a neurological assessment tool for the polytraumatized victim. Although some information may be ignored, because of the need for speed and flexibility of services, which should prioritize the stabilization of the victim and not the filling of information, those failures make the record incomplete and with no support for situations involving the justice^11,21.

In order to prevent the occurrence of traumatic events, reduce the severity of injuries, the occupation of hospital beds and rates of lost years and disabled, especially among young people, there should be investments in hazard and risk control strategies, using systematic measures for health promotion and disease prevention so that they can live their youth safely and without injury to health¹⁷.

Since the nurse is a professional focused on the implementation of health care in all life cycles, aiming at comprehensive care, he/she must be able to implement health education programs for the youngster and his/her family, planning strategies and targets to encourage harm reduction and safe behavior, in order to reduce the traumatic episodes¹⁷⁾⁽²².

Conclusions

One observed that, among the traumatic emergencies treated by the SAMU 192 RN from January to June 2014, there was a greater quantity of TA, followed by falls. Most involved were men, aged between 25 and 44 years (young adult). Most calls occurred during the weekend, with the highest number on Sunday. As for the relationship between the type of trauma and gender, both male as female young adults experienced a higher proportion of TA. As for the elderly, they were most affected by falls.

Regarding the severity of the trauma, most victims of traumatic emergencies were classified between 13 and 15 points (mild trauma) on the Glasgow coma scale and the individual, in most cases, did not suffer polytrauma. However, it is noteworthy the neglect of professionals regarding the annotation of the classification of the Glasgow coma scale, for it is an essential data for the assessment of the severity of the trauma. In addition, the data deficiency in service records hinders the development of researches, as well as in court proceedings, since there is no evidential document support.

One knows that deaths from external causes are considered a public health problem with high rates of deaths and high absenteeism numbers by irreversible sequelae involving young people. The rapid and qualified service to this type of occurrence is directly proportional to the prognosis of the victim. It is noteworthy the importance of continuing education for health professionals working in the prehospital setting, since the first hour, called golden hour, is considered crucial to the survival of people in emergency situations.