Emergency Medical Individual Clinician Volume and Mortality in Trauma Patients

doi:10.1001/jamasurg.2025.6741

Emergency Medical Individual Clinician Volume and Mortality in Trauma Patients

JAMA SurgPublished 1 Apr 2026Secondary analysis of the Linking Investigations in Trauma and Emergency Services (LITES) Task Order 1 prospective observational cohort study

Primary result · 6-hour mortalityResultAdjusted odds ratio 0.899 95% CI 0.811–0.996

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Authors' conclusion

Results of this cohort study suggest that higher patient volumes per EMS clinician were associated with lower early mortality rates after trauma.

Study context

Population: Severely injured patients (Injury Severity Score ≥9) transported to a trauma center by 1 air and 1 ground agency, 2017–2021359 clinicians
Participants: 3,649 participants

Comparison: Higher vs lower emergency medical services (EMS) crew mean 3-year adult trauma volume
Primary endpoint: 6-hour mortality
Follow-up: 6 hours

Methodological detailspatient-level risk-adjusted regression, Data analyzed February 2023 to June 2024

Patient-level risk-adjusted regression
Data analyzed February 2023 to June 2024

Primary result

As reported in the abstract

Adjusted odds ratio

0.899

95% CI 0.811–0.996

Increase of 5 adult trauma patients annually per crew

aOR 0.899 (95% CI 0.811–0.996)

Per crew, as printed

Further findings

6-hour mortality, TBI (subgroup)

	← Lower odds ←→ Higher odds →	aOR (95% CI)
Volume	0.512	0.974 (0.949–0.999)
	0.512Adjusted odds ratio (log scale)

6-hour mortality, prehospital shock (subgroup)

	← Lower odds ←→ Higher odds →	aOR (95% CI)
Volume	0.512	0.974 (0.949–0.999)
	0.512Adjusted odds ratio (log scale)

Outcome	Estimate
In-hospital mortality2.6% decrease in in-hospital mortality	aOR 0.974 (95% CI 949–0.999)
Scene time (EMS industry quality metric)	regression coefficient −0.134 (95% CI −0.191 to −0.077)

Scene time (EMS industry quality metric): decreasing scene time significantly associated with higher clinician volume

Mortality by highest crew-member trauma volume, nontrauma volume, years of experience

Not significantly associated with differences in mortality

Parts of this Brief are withheld: the automatic checks could not confirm them against the abstract.

Original publication

Emergency Medical Individual Clinician Volume and Mortality in Trauma Patients. JAMA Surg. Published 1 April 2026. doi:10.1001/jamasurg.2025.6741

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