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Abstract: Objective: To study severe head injured patients (SHIP) during prehospital emergency care (Samu) and the first day in the French Pays-de-la-Loire area, in 2005. Study design: Prospective and multicenter. Patients and methods: All patients managed by Samu with GCS≤8 on the field, starting from a GCS≤10. Results: We report on 125 patients (88% of all SHIP managed in 2005), including 114 with a GCS less or equal to eight on which analysis was performed: age: 37±20 years, men: 4/1, road accident: 73%, fall: 20%, (polytrauma: 53%, artificial ventilation: 92%). Delays: field medical care 54±28min, transportation: 32±29min, total time to hospital: 1h55±48min. Direct admission in a center with neurosurgery on site: 68%; 47% of patients admitted in general hospitals were transferred to a tertiary hospital (71% to neurosurgery). Mortality before 24th hour (23%) was associated (p <0.05) with shorter transfer time, older patient, persistent shock, fluid loading greater than 1500ml, continuous infusion of vasopressors, focal neurological deficit. Problems were reported by Samu teams (21% of cases): medical care (32%), emergency ambulance availability (20%), alerting process (16%), on field care before Samu (12%). Of note, mannitol was never used, despite a mydriasis. Conclusion: We observed a delayed referral of patients to a tertiary hospital, a limited use of CT image transmission and the absence of mannitol administration but also organisational problems reported in 21% of cases problems are main target for quality improvement. [Copyright &y& Elsevier]

Objective: To study severe head injured patients (SHIP) during prehospital emergency care (Samu) and the first day in the French Pays-de-la-Loire area, in 2005., Study Design: Prospective and multicenter., Patients and Methods: All patients managed by Samu with GCS

Serum concentrations of psychotropic drugs were measured in 363 drivers injured in road accidents and admitted to the emergency department of Angers regional university hospital. The figures obtained were correlated to the presumed responsibility of each driver in the accident. Benzodiazepines and phenobarbitone were found in the serum of 39 drivers, and responsibility was significantly increased in this group. The role played by these medicines in road accidents has often been alluded to in the literature, but the value of these previous studies was limited by the lack of quantitative assays. Measuring serum concentrations has permitted a more accurate analysis of the relationship between responsibility for road accident and consumption of psychotropic drugs, including barbiturates. This has prompted the authors to organize a regional information campaign intended for the general public and doctors and aimed at drawing attention to the higher risk of accident among road users taking these drugs.