title: The golden hour of shock - how time is running out: prehospital time intervals in Germany--a multivariate analysis of 15, 103 patients from the TraumaRegister DGU(R).
abstract: OBJECTIVE
  Although prehospital treatment algorithms have changed over the past years, the prehospital time of multiple trauma patients of some 70 min and the on-scene-treatment time (OST) of some 30 min have not changed since 1993. The aim of this study was to critically assess specific interventions and conditions at the scene in relation to their impact on prehospital rescue intervals.
  
  
  METHODS
  We performed a retrospective data analysis of all multiple injured patients from the TraumaRegister DGU (English: German Trauma Society) from January 1993 to December 2010. Exclusion criteria were missing or implausible data regarding prehospital timelines. With OST as an independent variable, different models of multivariate regression were performed to identify parameters with relevant impact on the OST.
  
  
  RESULTS
  15 103 datasets were included in this study. Based on the mean OST of 32.7 (± 18.6) min and a constant absolute term of 16.2 (± 1.5) min, we identified seven procedures and nine environmental parameters with significant impact on OST. Intubation (9.3 ± 0.8 min) and being a car occupant (8.0 ± 0.8 min) were associated with the most prolonged OSTs. A Glasgow Coma Scale ≤ 8 (-4.5 ± 0.7 min) and cardiopulmonary resuscitation (-2.8 ± 1.7 min) resulted in its most relevant reduction. Admission to a Level III facility led to a reduced overall prehospital time (60.0 ± 24.6 min) compared with Level I (70.0 ± 28.5 min) and II (66.8 ± 27.4 min) trauma centres.
  
  
  CONCLUSIONS
  This study identified characteristic interventions and conditions with significant impact on prehospital treatment times. Current treatment concepts should be re-evaluated with respect to these results.
authors.affiliation: Department of Trauma, Hand and Reconstructive Surgery, University Hospital of the Johann Wolfgang Goethe-University, , Frankfurt, Germany.
authors.forename: Hendrik
authors.initials: H
authors.lastname: Wyen
authors.forename: Rolf
authors.initials: R
authors.lastname: Lefering
authors.forename: Marc
authors.initials: M
authors.lastname: Maegele
authors.forename: Thomas
authors.initials: T
authors.lastname: Brockamp
authors.forename: Arasch
authors.initials: A
authors.lastname: Wafaisade
authors.forename: Sebastian
authors.initials: S
authors.lastname: Wutzler
authors.forename: Felix
authors.initials: F
authors.lastname: Walcher
authors.forename: Ingo
authors.initials: I
authors.lastname: Marzi
mesh_terms: D000328:Adult; D004632:Emergency Medical Services / Q000592:standards* / Q000706:statistics & numerical data; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000628:therapy*; D015999:Multivariate Analysis; D012042:Registries; D012189:Retrospective Studies; D012771:Shock, Hemorrhagic / Q000517:prevention & control / Q000628:therapy*; D013997:Time Factors; D061665:Time-to-Treatment