title: The time cost of prehospital intubation and intravenous access in trauma patients.
abstract: OBJECTIVE
  The prehospital management of trauma patients remains controversial. Little is known about the time each procedure contributes to the on-scene duration, and this information would be helpful in prioritizing which procedures to perform in the prehospital setting. We sought to estimate the contribution of procedures to on-scene duration focusing on intubation and establishment of intravenous (IV) access.
  
  
  METHODS
  Data were provided by the Office of Emergency Planning and Response at the Mississippi Department of Health. Real-time prehospital patient-level data are collected by emergency medical services (EMS) providers for all 9-1-1 calls statewide. Linear regression was performed to determine the overall additional time for an average procedure and to calculate marginal increases in on-scene time associated with the establishment of IV access and with endotracheal intubation. Analyses were performed using Stata 9.
  
  
  RESULTS
  During 2001-2005, 192,055 prehospital runs were made for trauma patients. 121,495 (63%) included prehospital procedures. Average on-scene duration for those runs was 15:24 (minutes:seconds). On average, each procedure was associated with an addition of 1 minute to the on-scene duration (95% confidence interval [CI]: 58-62 seconds). A scene involving the establishment of IV access was 5:04 longer, while one involving tracheal intubation was 2:36 longer.
  
  
  CONCLUSIONS
  We estimate the marginal increase in on-scene duration associated with the performance of an average procedure, establishment of IV access, and endotracheal intubation. There are policy and planning implications for the time trade-off of prehospital procedures, especially discretionary ones.
authors.affiliation: Robert Wood Johnson Clinical Scholars Program, Department of Emergency Medicine, University of Pennsylvania School of Medicine, and the Center for Outcomes Research at the Children's Hospital of Philadelphia, PA 19104-6021, USA. brendan.carr@uphs.upenn.edu
authors.forename: Brendan G
authors.initials: BG
authors.lastname: Carr
authors.forename: Tanguy
authors.initials: T
authors.lastname: Brachet
authors.forename: Guy
authors.initials: G
authors.lastname: David
authors.forename: Reena
authors.initials: R
authors.lastname: Duseja
authors.forename: Charles C
authors.initials: CC
authors.lastname: Branas
mesh_terms: D000328:Adult; D002406:Catheterization, Peripheral; D015331:Cohort Studies; D017598:Efficiency, Organizational; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal; D016014:Linear Models; D008297:Male; D008922:Mississippi; D015999:Multivariate Analysis; D012189:Retrospective Studies; D013647:Task Performance and Analysis; D013997:Time Factors; D014947:Wounds and Injuries / Q000628:therapy*