title: On-scene Times for Inter-facility Transport of Patients with Hypoxemic Respiratory Failure.
abstract: Introduction Inter-facility transport of critically ill patients is associated with a high risk of adverse events, and critical care transport (CCT) teams may spend considerable time at sending institutions preparing patients for transport. The effect of mode of transport and distance to be traveled on on-scene times (OSTs) has not been well-described. Problem Quantification of the time required to package patients and complete CCTs based on mode of transport and distance between facilities is important for hospitals and CCT teams to allocate resources effectively.
  
  
  METHODS
  This is a retrospective review of OSTs and transport times for patients with hypoxemic respiratory failure transported from October 2009 through December 2012 from sending hospitals to three tertiary care hospitals. Differences among the OSTs and transport times based on the mode of transport (ground, rotor wing, or fixed wing), distance traveled, and intra-hospital pick-up location (emergency department [ED] vs intensive care unit [ICU]) were assessed. Correlations between OSTs and transport times were performed based on mode of transport and distance traveled.
  
  
  RESULTS
  Two hundred thirty-nine charts were identified for review. Mean OST was 42.2 (SD=18.8) minutes, and mean transport time was 35.7 (SD=19.5) minutes. On-scene time was greater than en route time for 147 patients and greater than total trip time for 91. Mean transport distance was 42.2 (SD=35.1) miles. There were no differences in the OST based on mode of transport; however, total transport time was significantly shorter for rotor versus ground, (39.9 [SD=19.9] minutes vs 54.2 [SD=24.7] minutes; P <.001) and for rotor versus fixed wing (84.3 [SD=34.2] minutes; P=0.02). On-scene time in the ED was significantly shorter than the ICU (33.5 [SD=15.7] minutes vs 45.2 [SD=18.8] minutes; P <.001). For all patients, regardless of mode of transportation, there was no correlation between OST and total miles travelled; although, there was a significant correlation between the time en route and distance, as well as total trip time and distance.
  
  
  CONCLUSIONS
  In this cohort of critically ill patients with hypoxemic respiratory failure, OST was over 40 minutes and was often longer than the total trip time. On-scene time did not correlate with mode of transport or distance traveled. These data can assist in planning inter-facility transports for both the sending and receiving hospitals, as well as CCT services. Wilcox SR , Saia MS , Waden H , McGahn SJ , Frakes M , Wedel SK , Richards JB . On-scene times for inter-facility transport of patients with hypoxemic respiratory failure. Prehosp Disaster Med. 2016;31(3):267-271.
authors.affiliation: 1Division of Pulmonary,Critical Care, and Sleep Medicine,Division of Emergency Medicine,Medical University of South Carolina,Charleston,South CarolinaUSA.
authors.forename: Susan R
authors.initials: SR
authors.lastname: Wilcox
authors.affiliation: 2Boston MedFlight,Bedford,MassachusettsUSA.
authors.forename: Mark S
authors.initials: MS
authors.lastname: Saia
authors.affiliation: 2Boston MedFlight,Bedford,MassachusettsUSA.
authors.forename: Heather
authors.initials: H
authors.lastname: Waden
authors.affiliation: 2Boston MedFlight,Bedford,MassachusettsUSA.
authors.forename: Susan J
authors.initials: SJ
authors.lastname: McGahn
authors.affiliation: 2Boston MedFlight,Bedford,MassachusettsUSA.
authors.forename: Michael
authors.initials: M
authors.lastname: Frakes
authors.affiliation: 2Boston MedFlight,Bedford,MassachusettsUSA.
authors.forename: Suzanne K
authors.initials: SK
authors.lastname: Wedel
authors.affiliation: 1Division of Pulmonary,Critical Care, and Sleep Medicine,Division of Emergency Medicine,Medical University of South Carolina,Charleston,South CarolinaUSA.
authors.forename: Jeremy B
authors.initials: JB
authors.lastname: Richards
mesh_terms: D015897:Comorbidity; D003422:Critical Care; D006801:Humans; D000860:Hypoxia; D008297:Male; D012131:Respiratory Insufficiency; D012189:Retrospective Studies; D013997:Time Factors; D014187:Transportation of Patients / Q000379:methods; D014481:United States
keywords: CCT critical care transport; ED emergency department; EMS Emergency Medical Services; EMT emergency medical technician; Emergency Medical Services; HEMS helicopter Emergency Medical Services; ICU intensive care unit; OST on-scene time; critical care transport; on-scene time; scene time; transport time