Abstract
BackgroundA reduction in pre-hospital scene time for patients with penetrating trauma is associated with reduced mortality, when combined with appropriate hospital triage. This study investigated the relationship between presence of pre-hospital enhanced care teams (ECT) (Critical Care Paramedics (CCPS) or Helicopter Emergency Medical Service (HEMS)), on the scene time and triage compliance, of penetrating trauma patients in a UK ambulance service. The primary outcome was whether scene time reduces when an ECT is present. A secondary outcome was whether the presence of an ECT improved compliance with the trust’s Major Trauma Decision Tree (MTDT).MethodsAll suspected penetrating trauma incidents involving a patient’s torso were identified from the Trust’s computer-aided dispatch (CAD) system between 31st March 2017 and 1st April 2018. Only patients who sustained central penetrating trauma were included. Any incidents involving firearms were excluded due to the prolonged times that can be involved when waiting for specialist police units. Data relevant to scene time for each eligible incident were retrieved, along with the presence or absence of an ECT. The results were analysed to identify trends in the scene times and compliance with the MTDT.ResultsOne hundred seventy-one patients met the inclusion criteria, with 165 having complete data. The presence of an ECT improved the median on-scene time in central stabbing by 38% (29m50s vs. 19m0s, p = 0.03). The compliance with the trust’s MTDT increased dramatically when an ECT is present (81% vs. 37%, odds ratio 7.59, 95% CI, 3.70–15.37, p < 0.0001).ConclusionsThe presence of an ECT at a central stabbing incident significantly improved the scene time and triage compliance with a MTDT. Ambulance services should consider routine activation of ECTs to such incidents, with subsequent service evaluation to monitor patient outcomes. Ambulance services should continue to strive to reduce scene times in the context of central penetrating trauma.
Highlights
A reduction in pre-hospital scene time for patients with penetrating trauma is associated with reduced mortality, when combined with appropriate hospital triage
It is acknowledged within this evaluation that if a stabbing incident was incorrectly categorised, it could be missing from the dataset
For enhanced care teams (ECT) overall this was 19 min (IQR 12–30 min), 19 min if a Critical Care Paramedics (CCPs) was in attendance (IQR 12–30 min), 21 min if Helicopter Emergency Medical Service (HEMS) attended (IQR 10–34 min), and 18.5 min if both ECT units attended (IQR 13.75–32 min)
Summary
A reduction in pre-hospital scene time for patients with penetrating trauma is associated with reduced mortality, when combined with appropriate hospital triage. The development of the ‘Golden Hour’ is a widely accepted doctrine attributed to R Adams Cowley [5] and later supported in various studies [6, 7] Whilst it has not been without contention; a large prospective trial failed to find a correlation between pre-hospital intervals and in-hospital mortality [8], the general premise has been widely accepted, and developed to include the concept of the “Platinum ten minutes”. This states that pre-hospital care teams treating major trauma patients (such as victims of penetrating central trauma), should aim to remain on scene for just ten minutes or less [9]. The exact origin of the ten minute figure is unclear, but the time criticality of such patients is undeniable, and has recently been shown clearly by a study looking at HEMS units in Texas [10]
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