The Korean Journal of Emergency Medical Services (한국응급구조학회지)

The Korea Society of Emergency Medical Services (한국응급구조학회)
권호 표지
DOI QR코드

DOI QR Code

The effects of prehospital care on on-scene time in patients with major trauma

중증외상환자에서 병원전 외상 처치가 현장체류시간에 미치는 영향

  • Yang, Jin-Cheol (Daejeon metropolitan city Fire Headquarters Respondence Division) ;
  • Moon, Jun-Dong (Department of Emergency medical Service, Kongju National University)
  • Received : 2020.03.14
  • Accepted : 2020.04.19
  • Published : 2020.04.30
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: Effective time management, as well as life-saving care, are important in maximizing the prognosis of patients who have sustained major traumas. This study evaluated the appropriateness of emergency medical system (EMS) provider's essential care and how this care impacted on-scene time in patients with major traumas. Methods: This retrospective observational study analyzed the EMS major trauma documents, classified according to the physiological criteria (Glasgow coma scale <14, systolic blood pressure <90mmHg, Respiration rate <10 or >29) in Daejeon, from January, 2015 to December, 2018. Results: Of the 707 major trauma cases, the mean on-scene time was 7.75±4.64 minutes. According to EMS guidelines, essential care accuracy was 67.5% for basic airway, 36.4% for advanced airway, 91.2% for cervical collar, 81.5% for supplemental oxygen, 47.0% for positive pressure ventilation, 19.9% for intravenous access and fluid administration, and 96.0% for external hemorrhage control. Factors affecting on-scene time were positive pressure ventilation (p<.004), and intravenous access and fluid administration (p<.002). Conclusion: Adherence to guidelines was low during advanced airway procedures, positive pressure ventilation, intravenous access, and fluid administration. In addition, the on-scene time was prolonged when the practitioner provided positive pressure ventilation, intravenous access, and fluid administration; however, these durations did not exceed the recommended 10 minutes.

Keywords

References

  1. Harmsen AM, Giannakopoulos GF, Moerbeek PR, Jansma EP, Bonjer HJ, Bloemers FW. The influence of prehospital time on trauma patients outcome: a systematic review. Injury 2015;46(4):602-9. https://doi.org/10.1016/j.injury.2015.01.008
  2. Cowley RA. A total emergency medical system for the state of Maryland. Md State Med J. 1975;45:37-45. PMID:1142842
  3. Rogers FB, Rittenhouse KJ, Gross BW. The golden hour in trauma: dogma or medical folklore?. Injury 2015;46(4):525-7. https://doi.org/10.1016/j.injury.2014.08.043
  4. Brown J, Rosengart M, Forsythe R, Reynolds B, Gestring M, Hallinan W et al. Not all prehospital time is equal: influence of scene time on mortality. J Trauma Acute Care Surg. 2016;81(1):93-100. https://doi.org/10.1097/TA.0000000000000999
  5. Pham H, Puckett Y, Dissanaike S. Faster on-scene times associated with decreased mortality in Helicopter Emergency Medical Services (HEMS) transported trauma patients. Trauma Surg Acute Care Open 2017;2(1):e000122. https://doi.org/10.1136/tsaco-2017-000122
  6. McCoy CE, Menchine M, Sampson S, Anderson C, Kahn C. Emergency medical services out-of-hospital scene and transport times and their association with mortality in trauma patients presenting to an urban level I trauma center. Ann Emerg Med 2013;61(2):167-174. https://doi.org/10.1016/j.annemergmed.2012.08.026
  7. Williamson K, Ramesh R, Grabinsky A. Advances in prehospital trauma care. Int J Crit Illn Inj Sci 2011;1(1):44-50. https://doi.org/10.4103/2229-5151.79281
  8. National association of emergency medical technicians. Prehospital trauma life support. 8th ed. 2016. 137-8.
  9. American College of Surgeons. Advanced Trauma Life Support for student course manual, 10th edition, Feb. 2018. 4-5.
  10. Center for Disease Control and Prevention. Guidelines for field triage of injured patients: recommendations of the national expert panel on field triage 2011. MMWR 2012;61:1-21.
  11. National fire agency 119. The standard guidelines for 119 Emergency Medical Service Providers. 6th ed. Nov. 2018.
  12. Mackenzie EJ, Rivara FP, Jurkovich GJ, Nathens AB, Frey KP, Egleston BL et al. A national evaluation of the effect of trauma center care on mortality. N Engl J Med 2006;354;366-78. https://doi.org/10.1056/NEJMsa052049
  13. Ministry of health and welfare. Preventable death rate final report. Feb. 2017. 24-40.
  14. Ministry of health and welfare. Appropriacy analysis of emergency medical services on scene and in transportation. Aug. 2009.
  15. Ministry of public safety and security. Emergency medical service statistics annual report. May. 2017. 150-5.
  16. Slovis CM, Herr EW, Londorf D, Little TD, Alexander BR, Guthmann RJ. Success rates for initiation of intravenous therapy en route by prehospital care providers. Am J Emerg Med 1990;8(4):305-7. https://doi.org/10.1016/0735-6757(90)90080-j
  17. Harmsen AM, Giannakopoulos GF, Moerbeek PR, Jansma EP, Bonjer HJ, Bloemers FW. The influence of prehospital time on trauma patients outcome: a systematic review. Injury 2015;46(4):602-9. https://doi.org/10.1016/j.injury.2015.01.008
  18. Spaite DW, Tse DJ, Valenzuela TD, Criss EA, Meislin HW, Mahoney M et al. The impact of injury severity and prehospital procedures on scene time in victims of major trauma. Ann Emerg Med 1991;20(12):1299-305. https://doi.org/10.1016/s0196-0644(05)81070-4