Prehospital Trauma Scene and Transport Times for Pediatric and Adult Patients

Abstract

Introduction: Increased out-of-hospital time is associated with worse outcomes in trauma. Sparse literature exists comparing prehospital scene and transport time management intervals between adult and pediatric trauma patients. National Emergency Medical Services guidelines recommend that trauma scene time be less than 10 minutes. The objective of this study was to examine prehospital time intervals in adult and pediatric trauma patients. Methods: We performed a retrospective cohort study of blunt and penetrating trauma patients in a fivecounty region in North Carolina using prehospital records. We included patients who were transported emergency traffic directly from the scene by ground ambulance to a Level I or Level II trauma center between 2013-2018. We defined pediatric patients as those less than 16 years old. Urbanicity was controlled for using the Centers for Medicare and Medicaid's Ambulance Fee Schedule. We performed descriptive statistics and linear mixed-effects regression modeling. Results: A total of 2179 records met the study criteria, of which 2077 were used in the analysis. Mean scene time was 14.2 minutes (95% confidence interval [CI], 13.9-14.5) and 35.3% (n = 733) of encounters had a scene time of 10 minutes or less. Mean transport time was 17.5 minutes (95% CI, 17.0-17.9). Linear mixed-effects regression revealed that scene times were shorter for pediatric patients (p<0.0001), males (p=0.0016), penetrating injury (p<0.0001), and patients with blunt trauma in rural settings (p=0.005), and that transport times were shorter for males (p = 0.02), non-White patients (p<0.0001), and patients in urban areas (p<0.0001). Conclusion: This study population largely missed the 10-minute scene time goal. Demographic and patient factors were associated with scene and transport times. Shorter scene times occurred with pediatric patients, males, and among those with penetrating trauma. Additionally, suffering blunt trauma while in a rural environment was associated with shorter scene time. Males, non-White patients, and patients in urban environments tended to have shorter transport times. Future studies with outcomes data are needed to identify factors that prolong out-of-hospital time and to assess the impact of out-of-hospital time on patient outcomes. [West J Emerg Med. 2020;21(2)455-462.]

Variation in on-scene time of emergency medical services and the extent of the difference of on-scene time between genders: a retrospective population-based registry study in Riyadh Province, Saudi Arabia

“…Children represented 3.7% of EMS missions and had significantly shorter OST. Our study is consistent with multiple studies that found children’s OST to be significantly shorter than adults 27 28. In our study, elderly patients had by far the longest median OST.…”

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Prehospital Cross-Sectional Study of Drowning Patients Across the United States

“…Although the reasons for a faster response with African American patients are unclear, this could be because African American populations tend to concentrate around urban centers, which have higher concentrations of EMS bases and proximity to hospitals. 24,25 On-scene time was 19±17 min, longer than the target 10 min on-scene time adopted by most EMS systems. This reflects a possibly prolonged extrication requirement and on-scene resuscitation attempt.…”

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