Luisa Montoya., The University of Auckland, Auckland, NZ
Statistician, Master’s in Clinical Epidemiology and currently a PhD student in Population Health at the University of Auckland. Experience in the health sector, with projects that have been focused on the analysis of environmental pollution, violence, trauma, and cancer control and prevention in Colombia. Experience in university teaching at the undergraduate and graduate levels.
Distribution of Total Prehospital Time to First Hospital for Major Trauma Cases
Montoya, L., University of Auckland, Auckland, New Zealand Kool, B., University of Auckland, Auckland, New Zealand Dicker, B., St John, Auckland, New Zealand Davie, G., University of Otago, Dunedin, New Zealand
Introduction: Time is an important determinant of trauma outcome. In New Zealand (NZ), patients are dying in the prehospital setting from injuries that are potentially survivable. Optimising prehospital trauma systems and care, such as reducing prehospital times, and ensuring people get to the appropriate receiving facility quickly are necessary to contribute to a reduction in serious injury-related mortality and morbidity.
Aim: To determine the distribution of total prehospital time (activation, response, on-scene and transport) to first hospital for major trauma cases attended by Emergency Medical Services (EMS) in NZ.
Methods: In this retrospectively-designed prospective cohort study analysing routinely collected data, individuals attended by an EMS provider after suffering major trauma between 1 December 2016 and 30 November 2018 were included. Qualitative variables are shown as frequencies and percentages. Quantitative variables are described using mean, standard deviation, median, interquartile range (IQR) and/or 95% confidence intervals (CI).
Results: 3,353 cases met the eligibility criteria. Median age was 48 years (IQR: 27-65), 69.6% were male, 57.3% were NZ European and 21.3% were NZ Māori. There were 108 prehospital deaths. From call pick up to arrival at first hospital, EMS providers spent on average 110.9 minutes (CI: 107.9-113.8). Activation time contributed 11% of total prehospital time, while response time, on-scene time and transport time contributed 26%, 31% and 32% respectively.
Conclusions: In NZ, total prehospital time is nearly double of the optimal time recommended to provide advanced-level hospital care to major trauma patients (‘golden hour’) (Harmsen 2015). Reducing the 37% (activation and response time) in which no EMS care is provided to the patient should improve patient outcomes.
References: Harmsen, A et al 2015, ‘The influence of prehospital time on trauma patients outcome: A systematic review’, Injury, vol. 46, pp. 602–09.