The old “scoop and run” vs “stay and play” debate has gone on for years. It would seem to be intuitive that trauma patients, who should be assumed to be bleeding to death, would do better with shorter prehospital times and quicker transport to definitive care.
However, several studies have not shown worse outcomes in the “stay and play” patients. Once again, mortality is a very crude indicator of “worse” outcomes, and may not be a good enough measure. Nonetheless, the debate continues to rage. A group at the University of Pittsburgh used the Pennsylvania Trauma Registry to review a huge number of EMS transports, looking at mortality as the measure of interest.
Recognizing that total prehospital time can be influenced by delays in specific phases (response, scene, or transport), they analyzed the impact of problems in each. If one particular phase represented more that 50% of the total prehospital time, it was considered a delay. Logistical regression was used to match patients to try to control for any confounding issues.
Here are the factoids:
- Over 164,000 records with prehospital times were reviewed over a 14 year period.
- There was a statistically significant increase in mortality if the scene time phase was prolonged.
- No differences in mortality were noted with longer response or transport times.
- Prolonged extrication and intubation had a tendency to prolong scene time, and were independently associated with higher mortality.
- Lengthy scene time without extrication or intubation was not associated with higher mortality.
Bottom line: This registry-based study has helped us to slice and dice the prehospital time issue a little bit better. As with other studies, the times themselves may not necessarily be the problem. It’s what is causing the delay that matters. Extrication and intubation tend to indicate sicker trauma patients, but they are also somewhat unavoidable. Prehospital trauma professionals will need to focus on tools and exercises that save time during these critical interventions.
Reference: Not all prehospital time is equal: influence of scene time on mortality. EAST 2016 Oral abstract #9, resident research competition.