Factors influencing on-scene time in a rural Norwegian helicopter emergency medical service: a retrospective observational study.
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine · 2017-09-21 · Observational study
Abstract
BACKGROUND: Critically ill patients need to be immediately identified, properly managed, and rapidly transported to definitive care. Extensive prehospital times may increase mortality in selected patient groups. The on-scene time is a part of the prehospital interval that can be decreased, as transport times are determined mostly by the distance to the hospital. Identifying factors that affect on-scene time can improve training, protocols, and decision making. Our objectives were to assess on-scene time in the Helicopter Emergency Medical Service (HEMS) in our region and selected factors that may affect it in specific and severe conditions. METHODS: This retrospective cohort study evaluated on-scene time and factors that may affect it for 9757 emergency primary missions by the three HEMSs in western Norway between 2009 and 2013, using graphics and descriptive statistics. RESULTS: The overall median on-scene time was 10 minutes (IQR 5-16). The median on-scene time in patients with penetrating torso injuries was 5 minutes (IQR 3-10), whereas in cardiac arrest patients it was 20 minutes (IQR 13-28). Based on multivariate linear regression analysis, the severity of the patient's condition, advanced interventions performed, mode of transport, and trauma missions increased the on-scene time. Endotracheal intubation increased the OST by almost 10 minutes. Treatment prior to HEMS arrival reduced the on-scene time in patients suffering from acute myocardial infarction. DISCUSSION: We found a short OST in preselected conditions compared to other studies. For the various patient subgroups, the strength of association between factors and OST varied. The time spent on-scene and its influencing factors were dependent on the patient's condition. Our results provide a basis for efforts to improve decision making and reduce OST for selected patient groups. CONCLUSIONS: The most important factors associated with increased on-scene time were the severity of the patient's condition, the need for intubation or intravenous analgesic, helicopter transport, and trauma missions.