Scoop and run or stay and play. Is one better that the other? Over my last two posts, I reviewed a couple of papers that were older (6-7 years) and had smaller patient groups. Now let’s look at a more recent one with a larger experience using a state trauma registry.
This one is from the Universities of Pittsburgh and Rochester, and used the Pennsylvania state trauma registry for study material. The authors wanted to really slice and dice the data, postulating that previous studies were not granular enough, such that significant trends could not be seen due to lumping all prehospital time together. They divided prehospital time into three components: response time, scene time, and transport time. To some degree, the first and third components are outside of the prehospital providers’ control.
The records for over 164,000 patients were analyzed. These only included those for patients transported from the scene by EMS, and excluded burns. The prehospital time (PH time) was divided into the three components above. A component was determined to be prolonged if it contributed > 50% of the total PH time.
Here are the factoids:
- Half of the patients had a prolonged PH time interval (52%)
- Response time was prolonged in only 2%, scene time was prolonged in 19%, and transport time was longer in 31%
- Mortality was 21% higher in those with a prolonged scene time component
- There was no mortality difference in patients with no prolonged time components, or those with prolonged response or transport times
- These patterns held for both blunt and penetrating injury
- Extrication and intubation were common reasons for prolonged scene time. Extrication added an average of 4.5 minutes, and intubation 6.5 minutes.
- Mortality was increased with prehospital intubation, but this effect lessened in severe TBI
- Increasing experience with extrication and intubation appeared to decrease the mortality from the increased scene time they caused
Bottom line: This paper suggests that the dichotomy of “scoop and run” vs “stay and play” may be too crude, and that a more nuanced approach should be considered. In plain English, the optimal management lies somewhere in between these polar opposites. Actual on scene time appears to be the key interval. EMS providers need to be aware of scene time relative to response and transport times. Patients with specific injury patterns that benefit from short scene times (hypotension, flail, penetrating injury) can quickly be identified and care expedited. Increased scene time due extrication cannot be avoided, but prehospital intubation needs to be considered carefully due to the potential to increase mortality in select patients.
Reference: Not all prehospital time is equal: Influence of scene time on mortality. J Trauma 81(1):93-100, 2016.