From Roadside to Hospital: A Pilot Study to Investigate the Factors Influencing the Time Taken to Deliver Trauma Patients to a Regional Hospital

Abstract

Introduction One of the trauma system objectives for the ambulance service is to get the right patient to the right hospital in a timely manner. The Review of Trauma and Emergency Services in Victoria, Australia, identified prolonged prehospital scene times of greater than 20 minutes for non trapped patients as a deficiency that may have adverse outcomes for severely injured trauma patients. The objective of this pilot study was to identify the factors that impact on the timely transfer of trauma patients from the scene of an incident to a regional hospital emergency department and justification for the delays, as the basis for a further detailed study. Methods A retrospective pilot cohort study of trauma patients transported by ambulance to the emergency department of the Latrobe Regional Hospital over a six-month period who had an emergency department triage category of 1, 2 or 3 was undertaken. Data relating to the prehospital care of trauma patients with scene times > 20 minutes and transport times > 30 minutes were extracted from Rural Ambulance Victoria patient care records and hospital patient records. Ethics approval was granted. Results There were 70 trauma patients transported to the hospital during the collection period. Of these 49 patients were available for analysis, 21 cases were excluded due to incomplete time or ED triage details. There were 12 cases where scene times were > 20 minutes. Only one paramedic crew spent an unjustifiably long time at the scene and only one patient had a transport time to hospital > 30 minutes. Conclusion This pilot study confirms that there are prolonged prehospital scene times involving paramedics, however, the study suggests that most of the extended times are explained by factors outside the control of the attending paramedics. There was only one case where the scene time was not justified. One patient had a transport time > 30 minutes which was due to the patient being taken to a higher level of care. Experiences from this pilot study have led to changes in subsequent prehospital trauma studies.