Paramedics’ Perspectives on Factors Impacting On-Scene Times for Trauma Calls

Levitan, Mark; Law, Madelyn P.; Ferron, Richard; Lutz-Graul, K.

doi:10.1017/s1049023x18000389

Cited by 8 publications

(5 citation statements)

References 24 publications

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“…al. interviewed paramedics on factors affecting onscene time and found that scene characteristics (patient, bystander, location or weather), allied service (police or fire crews), accuracy of information from dispatch, ability to manage the scene, equipment, and implementation of policies are the barriers to reducing on-scene time [27]. In the current study, on-scene time was the longest in the Tohwa area.…”

Section: Discussionmentioning

confidence: 61%

Factors associated with EMS on-scene time and its regional difference in road traffic injuries: a population-based observational study

et al. 2022

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Background The outcome of road traffic injury (RTI) is determined by duration of prehospital time, patient’s demographics, and the type of injury and its mechanism. During the emergency medical service (EMS) prehospital time interval, on-scene time should be minimized for early treatment. This study aimed to examine the factors influencing on-scene EMS time among RTI patients. Methods We evaluated 19,141 cases of traffic trauma recorded between April 2014 and March 2020 in the EMS database of the Nara Wide Area Fire Department and the prehospital database of the emergency Medical Alliance for Total Coordination of Healthcare (e-MATCH). To examine the association of the number of EMS phone calls until hospital acceptance, age ≥65 years, high-risk injury, vital signs, holiday, and nighttime (0:00–8:00) with on-scene time, a generalized linear mixed model with random effects for four study regions was conducted. Results EMS phone calls were the biggest factor, accounting for 5.69 minutes per call, and high-risk injury accounted for an additional 2.78 minutes. Holiday, nighttime, and age ≥65 years were also associated with increased on-scene time, but there were no significant vital sign variables for on-scene time, except for the level of consciousness. Regional differences were also noted based on random effects, with a maximum difference of 2 minutes among regions. Conclusions The number of EMS phone calls until hospital acceptance was the most significant influencing factor in reducing on-scene time, and high-risk injury accounted for up to an additional 2.78 minutes. Considering these factors, including regional differences, can help improve the regional EMS policies and outcomes of RTI patients.

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Section: Discussionmentioning

confidence: 61%

Factors associated with EMS on-scene time and its regional difference in road traffic injuries: a population-based observational study

et al. 2022

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“…Several participants suggested that NQPs carry out more actions on scene, which may contribute to extended OST. Previous literature exploring Canadian paramedic perspectives on trauma care suggests that greater experience may lead to better OST management ( Levitan et al, 2018 ). Similarly, Robinson (2017) highlights literature which demonstrates a relationship between experience and clinical decision making, resource management and rapid treatment, while Holmes et al (2017) indicates that student paramedics are generally less confident in their clinical decision making, which may lead them to spend extra time on scene.…”

Section: Discussionmentioning

confidence: 99%

A qualitative exploration of ambulance clinician behaviour and decision making to identify factors influencing on-scene times for suspected stroke patients in North East England

Alton,

Shaw,

Finch

et al. 2024

British Paramedic Journal

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Aims/objectives: Ambulance clinician assessment of suspected stroke patients aims to provide rapid access to specialist care, however regional and national data show increasing pre-hospital times. This study explored paramedic views about factors contributing to on-scene time (OST) for suspected stroke patients, with a view to identifying opportunities for future interventions, to reduce OST.Methods: Views of paramedics from one regional service on factors influencing OST were explored using a qualitative approach. Semi-structured interviews with volunteers were recorded, transcribed and analysed using thematic analysis.Results: Interviews were conducted with 13 paramedics between August and November 2021. Five interlinked themes were identified and described a range of factors influencing OST: <list id="list1" list-type="order"> <list-item>‘Initial assessment and sources of information’ describes how clinicians make assessments based on initial presentation, influenced by pre-arrival information from ambulance control and family members / bystanders at the scene, and how this influences OST.</list-item> <list-item>‘Suitability for treatment and interventions’ describes how paramedics consider actions such as the face, arms, speech test, cannulation, electrocardiograms and neurological assessments while recognising that pre-hospital interventions for suspected stroke are limited.</list-item> <list-item>‘The environment’ describes the influence of incident setting on OST, including the overall process needed to transport the patient to appropriate care.</list-item> <list-item>‘Hospital interactions’ describes how interactions with hospital staff influenced paramedic actions and OST.</list-item> <list-item>‘Changing practice’ describes the influence of experience and interaction with hospital staff leading to changes in paramedic practice over time.</list-item> </list>Conclusion: This study provides insight into how UK paramedics spend time on scene with stroke patients. Multiple factors influencing OST were identified which signpost opportunities for interventions designed to reduce OST. Standardising on-scene assessments for stroke patients, refining communication processes between ambulance services and hospital stroke services and increasing availability of stroke continuing professional development for paramedics were all identified as potential targets for improving OST.

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“…Fire accidents, natural disasters, and motor vehicle accidents are known predictors of prolonged OSTs [ 1 , 33 ]. Performing patient extrication, assessment, emergency care, and procedures by EMS personnel, such as spinal immobilization and intravenous access, are required on the scene before transportation, regardless of disease or injury severity.…”

Section: Discussionmentioning

confidence: 99%

“…These activities can account for prolonged OSTs. Furthermore, the presence of allied services such as police officers and firefighters can influence the OSTs after these accidents [ 33 ]. The waiting time for their arrival and communication with them tends to increase OSTs.…”

Section: Discussionmentioning

confidence: 99%

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Factors associated with prolonged on-scene time in ambulance transportation among patients with minor diseases or injuries in Japan: a population-based observational study

Ueno,

Teramoto,

Nishioka

et al. 2024

BMC Emerg Med

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Background Prolonged prehospital time is a major global problem in the emergency medical system (EMS). Although factors related to prolonged on-scene times (OSTs) have been reported in patients with trauma and critical medical conditions, those in patients with minor diseases or injuries remain unclear. We examined factors associated with prolonged OSTs in patients with minor diseases or injuries. Methods This population-based observational study used the ambulance transportation and request call record databases of the Higashihiroshima Fire Department, Japan, between January 1, 2016, and December 31, 2022. The participants were patients with minor diseases or injuries during the study period. We performed a multivariable logistic regression analysis with robust error variance to examine the association between patient age, sex, severity, accident type, date and time of ambulance call, and the coronavirus disease 2019 (COVID-19) pandemic with prolonged OSTs. Prolonged OST was defined as ≥ 30 min from the ambulance arrival at the scene to departure. Results Of the 60,309 people transported by ambulance during the study period, 20,069 with minor diseases or injuries were included in the analysis. A total of 1,241 patients (6.2%) experienced prolonged OSTs. Fire accidents (adjusted odds ratio [aOR]: 7.77, 95% confidence interval [CI]: 3.82–15.79), natural disasters (aOR: 28.52, 95% CI: 2.09–389.76), motor vehicle accidents (aOR: 1.63, 95% CI: 1.30–2.06), assaults (aOR: 2.91, 95% CI: 1.86–4.53), self-injuries (aOR: 5.60, 95% CI: 3.37–9.32), number of hospital inquiries ≥ 4 (aOR: 77.34, 95% CI: 53.55–111.69), and the COVID-19 pandemic (aOR: 2.01, 95% CI: 1.62–2.50) were associated with prolonged OSTs. Moreover, older and female patients had prolonged OSTs (aOR: 1.18, 95% CI: 1.01–1.36 and aOR: 1.12, 95% CI: 1.08–1.18, respectively). Conclusions Older age, female sex, fire accidents, natural disasters, motor vehicle accidents, assaults, self-injuries, number of hospital inquiries ≥ 4, and the COVID-19 pandemic influenced prolonged OSTs among patients with minor diseases or injuries. To improve community EMS, we should reconsider how to intervene with potentially modifiable factors, such as EMS personnel performance, the impact of the presence of allied services, hospital patient acceptance systems, and cooperation between general emergency and psychiatric hospitals.

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Paramedics’ Perspectives on Factors Impacting On-Scene Times for Trauma Calls

Cited by 8 publications

References 24 publications

Factors associated with EMS on-scene time and its regional difference in road traffic injuries: a population-based observational study

Factors associated with EMS on-scene time and its regional difference in road traffic injuries: a population-based observational study

A qualitative exploration of ambulance clinician behaviour and decision making to identify factors influencing on-scene times for suspected stroke patients in North East England

Factors associated with prolonged on-scene time in ambulance transportation among patients with minor diseases or injuries in Japan: a population-based observational study

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