Factors associated with non-optimal resource utilization of air ambulance for interfacility transfer of injured patients.

Abstract

Timely access to definitive care is associated with improved outcomes in trauma patients. The goal of this study is to identify patient, institutional and paramedic risk factors for non-optimal resource utilization for interfacility transfers of injured adult patients transported by air ambulance to a LTC. This is a retrospective cohort study of adult emergent interfacility transports via Ornge with data collected on patient demographics, clinical status, sending facilities, transport details and paramedic qualifications. A logistic regression model was used to analyze data. 1777 injured patients undergoing transport with Ornge were analyzed with 805 of these undergoing non-optimal transport. Patients who had an optimal resource use were found to be older and mechanically ventilated. Risk factors increasing odds of non-optimal transport included patients transported from a nursing station (OR 1.94), transport with primary or advanced care paramedics (OR 6.57 and 1.44, respectively) and transport between both 0800-1700 and 1700-0000 (OR 1.40 and 1.54, respectively). The median delay to arrival to receiving facility if a patient had a non-optimal resource use was 40 minutes. Three main risk factors were identified in this study. We believe that nursing stations as a sending facility and type of paramedics crew transporting patients resulted in non-optimal resource utilization primarily due to triage of lower acuity patients. However the timing of day is more likely to be a resource availability issue and something that can be further studied and potentially improved moving forward.