Retrospective Study of EMS Scene Times and Mortality in Penetrating Trauma Patients: Improving Transport Standards and Patient Outcomes.

Abstract

This study aimed to determine the impact of emergency medical service (EMS) scene time variability on adult and pediatric trauma patient outcomes with moderate or severe penetrating injuries. This retrospective study analyzed the American College of Surgeons (ACS) Trauma Quality Improvement Program (TQIP) database between 2017 and 2020 to evaluate the relationship between EMS scene time on adult and pediatric patients with moderate to severe injuries. Primary outcomes included Dead on Arrival (DOA) to the Emergency Department (ED), ED mortality, 24-hour mortality, and in-hospital mortality. Multivariable logistic regression models were used to examine the association of each EMS scene time category and mortality. Adult patients with 10-30minutes of EMS scene time had increased odds of experiencing ED mortality, 24-hour mortality, and in-hospital mortality. Adults with >30minutes of EMS scene time were more likely to be DOA to the ED. There was no significant association with mortality for patients with <10minutes of EMS scene time. In the pediatric subset of patients, those with 10-30minutes of EMS scene time were more likely to experience ED mortality and in-hospital mortality. EMS scene times less than 10minutes were associated with the greatest odds of survival, supporting the "load and go" theory for penetrating trauma. Our study suggests that even an EMS scene time of 10-30minutes results in a significantly increased risk of mortality, and further efforts are needed to improve scene time through improved EMS and hospital policies.