Abstract
IntroductionMobilization of trauma resources has the potential to cause ripple effects throughout hospital operations. One major factor affecting efficient utilization of trauma resources is a discrepancy between the prehospital estimated time of arrival (ETA) as communicated by emergency medical services (EMS) personnel and their actual time of arrival (TOA). The current study aimed to assess the accuracy of the perceived prehospital estimated arrival time by EMS personnel in comparison to their actual arrival time at a Level II trauma center in San Bernardino County, California.MethodsThis retrospective study included traumas classified as alerts or activations that were transported to Arrowhead Regional Medical Center in 2013. We obtained estimated arrival time and actual arrival time for each transport from the Surgery Department Trauma Registry. The difference between the median of ETA and actual TOA by EMS crews to the trauma center was calculated for these transports. Additional variables assessed included time of day and month during which the transport took place.ResultsA total of 2,454 patients classified as traumas were identified in the Surgery Department Trauma Registry. After exclusion of trauma consults, walk-ins, handoffs between agencies, downgraded traumas, traumas missing information, and traumas transported by agencies other than American Medical Response, Ontario Fire, Rialto Fire or San Bernardino County Fire, we included a final sample size of 555 alert and activation classified traumas in the final analysis. When combining all transports by the included EMS agencies, the median of the ETA was 10 minutes and the median of the actual TOA was 22 minutes (median of difference=9 minutes, p<0.0001). Furthermore, when comparing the difference between trauma alerts and activations, trauma activations demonstrated an equal or larger difference in the median of the estimated and actual time of arrival (p<0.0001). We also found month and time of day to be associated with variability in the difference between the median of the estimated and actual arrival time (p=0.0082 and p=0.0005 for month and time of the day, respectively).ConclusionEMS personnel underestimate their travel time by a median of nine minutes, which may cause the trauma team to abandon other important activities in order to respond to the emergency department prematurely. The discrepancy between ETA and TOA is unpredictable, varying by month and time of day. As such, a better method of estimating patient arrival time is needed.
Highlights
Mobilization of trauma resources has the potential to cause ripple effects throughout hospital operations
emergency medical services (EMS) personnel underestimate their travel time by a median of nine minutes, which may cause the trauma team to abandon other important activities in order to respond to the emergency department prematurely
After exclusion of trauma consults (n=432), walk-ins, handoffs between agencies, downgraded trauma or traumas that were not classified (n=752), traumas with missing estimated time of arrival (ETA), time of arrival (TOA) or provider information (n=570), traumas where the arrival time was noted as earlier the call time (n=52), traumas transported by agencies other than American Medical Response (AMR), Ontario Fire, Rialto Fire, or San Bernardino County Fire (n=93), we included a sample size of 555 trauma alerts and activations in the final analysis. (See Figure 2 for patient flow chart.)
Summary
Mobilization of trauma resources has the potential to cause ripple effects throughout hospital operations. Trauma is the leading cause of death among Americans between the ages of 1 to 46 in the United States.[1,2] Trauma patients represent a heterogeneous group that are affected by a myriad of injury mechanisms. These patients often require rapid physician evaluation followed by a multitude of diagnostic procedures, imaging studies and therapeutic treatments.[3] As such, trauma places a significant socioeconomic burden on the U.S healthcare system and society as a whole. Following the introduction of Advanced Trauma Life Support in the 1970s, a coherent response to trauma has been shown to reduce mortality in this patient group.[4,5,6,7,8,9] Patients with multisystem injury are assessed by an organized team of professionals from a variety of specialized services.[8,10] This multidisciplinary group is known as the trauma team (Figure 1)
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