Determinants of on-scene time in injured patients treated by physicians at the site.
BACKGROUND
The controversy surrounding the use of advanced life support (ALS) for the pre-hospital management of trauma pivots on the fact that these procedures could cause significant and life-threatening delays to definitive in-hospital care. In Montreal, Québec, on-site ALS to injured patients is provided by physicians only. The purpose of this study was to identify parameters associated with the duration of scene time for patients with moderate to severe injuries treated by physicians at the scene.


OBJECTIVE
The use of on-site ALS by physicians is associated with a significant increase in scene time.


METHODS
A total of 576 patients with moderate to severe injuries are included in the analysis. This group was part of a larger cohort used in the prospective evaluation of trauma care in Montreal. Descriptive statistics, analysis of variance, multiple linear regression, and multiple logistic regression techniques were used to analyze the data.


RESULTS
Use of ALS in general was associated with a statistically significant increase in the mean scene time of 6.5 min. (p = .0001). Significant increases in mean scene time were observed for initiation of an intravenous route (mean = 6.6 min., p = .0001), medication administration (mean = 5.7 min., p = .0001), and pneumatic antishock garment (PASG) application (mean = 9.3 min., p = .03). Similar differences were observed for total prehospital time. A significant increase in the relative odds for having long scene times (> 20 min.) also was associated with the use of ALS. This level of scene time was associated with a significant increase in the odds of dying (OR = 2.6, p = .009).


CONCLUSIONS
This study shows that physician-provided, on-site ALS causes significant increase in scene time and total prehospital time. These delays are associated with an increase in the risk for death in patients with severe injuries.
Sampalis
J S
JS
Department of Surgery, McGill University, Montreal, Québec, Canada.
Lavoie
A
A
Salas
M
M
Nikolis
A
A
Williams
J I
JI
D000328:Adult; D000704:Analysis of Variance; D004632:Emergency Medical Services / Q000458:organization & administration*; D004634:Emergency Medical Technicians; D005260:Female; D006302:Health Services Research; D006801:Humans; D008020:Life Support Care / Q000458:organization & administration*; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008505:Medical Staff, Hospital; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D013997:Time Factors; D014947:Wounds and Injuries / Q000628:therapy*