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Multi-Institutional Multidisciplinary Injury Mortality Investigation in the Civilian Pre-Hospital Environment (MIMIC): a methodology for reliably measuring prehospital time and distance to definitive care
  1. Nicolas W Medrano1,
  2. Cynthia Lizette Villarreal1,
  3. Michelle A Price1,
  4. Ellen MacKenzie2,
  5. Kurt B Nolte3,
  6. Monica J Phillips1,
  7. Ronald M Stewart4,
  8. Brian J Eastridge4
  1. 1National Trauma Institute, San Antonio, Texas, USA
  2. 2Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
  3. 3Office of the Medical Investigator, University of New Mexico, Albuquerque, New Mexico, USA
  4. 4Department of Surgery, UT Health San Antonio, San Antonio, Texas, USA
  1. Correspondence to Mr Nicolas W Medrano, National Trauma Institute, San Antonio, TX 78230, USA; nick{at}


The detailed study of prehospital injury death is critical to advancing trauma and emergency care, as circumstance and causality have significant implications for the development of mitigation strategies. Though there is no true ‘Golden Hour,’ the time from injury to care is a critical element in the analysis matrix, particularly in patients with severe injury. Currently, there is no standard method for the assessment of time to definitive care after injury among prehospital deaths. This article describes a methodology to estimate total prehospital time and distance for trauma patients transported via ground emergency medical services and helicopter emergency medical services using a geographic information system. Data generated using this method, along with medical examiner and field investigation reports, will be used to estimate the potential survivability of prehospital trauma deaths occurring in five US states and the District of Columbia as part of the Multi-Institutional Multidisciplinary Injury Mortality Investigation in the Civilian Pre-Hospital Environment study. One goal of this work is to develop standard metrics for the assessment of total prehospital time and distance, which can be used in the future for more complex spatial analyses to gain a deeper understanding of trauma center access. Results will be used to identify high priority areas for research and development in injury prevention, trauma system performance improvement, and public health.

  • prehospital
  • preventable death
  • trauma
  • injury
  • geographic information system

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  • Contributors BJE devised the project and the main conceptual ideas of the MIMIC project. NWM designed the model and took the lead in drafting the article. All authors provided critical feedback and helped shape the research and article.

  • Funding This work was supported by the Office of the Assistant Secretary of Defense for Health Affairs, through the Defense Medical Research and Development Program under Award No W81XWH-17-2-0010.

  • Disclaimer The US Army Medical Research Acquisition Activity, 820 Chandler Street, Fort Detrick, MD 21702-5014 is the awarding and administering acquisition office. Opinions, interpretations, conclusions and recommendations are those of the authors and are not necessarily endorsed by the Department of Defense.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.