Wilcox Susan R, Saia Mark S, Waden Heather, McGahn Susan J, Frakes Michael, Wedel Suzanne K, Richards Jeremy B
1Division of Pulmonary,Critical Care, and Sleep Medicine,Division of Emergency Medicine,Medical University of South Carolina,Charleston,South CarolinaUSA.
2Boston MedFlight,Bedford,MassachusettsUSA.
Prehosp Disaster Med. 2016 Jun;31(3):267-71. doi: 10.1017/S1049023X16000315. Epub 2016 Mar 28.
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.
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.
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.
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.
引言 危重症患者在医疗机构间的转运与不良事件的高风险相关，重症监护转运（CCT）团队可能会在转诊机构花费大量时间为患者的转运做准备。运输方式和行程距离对现场时间（OST）的影响尚未得到充分描述。问题 根据运输方式和机构间距离对患者进行打包和完成CCT所需时间的量化，对于医院和CCT团队有效分配资源很重要。
这是一项对2009年10月至2012年12月从转诊医院转运至三家三级医疗机构的低氧性呼吸衰竭患者的OST和转运时间的回顾性研究。评估了基于运输方式（地面、旋翼机或固定翼）、行程距离和院内接送地点（急诊科[ED]与重症监护病房[ICU]）的OST和转运时间的差异。根据运输方式和行程距离对OST和转运时间进行相关性分析。
共确定239份病历进行审查。平均OST为42.2（标准差=18.8）分钟，平均转运时间为35.7（标准差=19.5）分钟。147例患者的现场时间大于途中时间，91例患者的现场时间大于总行程时间。平均转运距离为42.2（标准差=35.1）英里。基于运输方式的OST没有差异；然而，旋翼机转运的总运输时间明显短于地面转运（39.9[标准差=19.9]分钟对54.2[标准差=24.7]分钟；P<.001），旋翼机转运也短于固定翼转运（84.3[标准差=34.2]分钟；P=0.02）。急诊科的现场时间明显短于ICU（33.5[标准差=15.7]分钟对45.2[标准差=18.8]分钟；P<.001）。对于所有患者，无论运输方式如何，OST与总行程英里数之间均无相关性；尽管途中时间与距离以及总行程时间与距离之间存在显著相关性。
在这组低氧性呼吸衰竭的危重症患者中，OST超过40分钟，且通常长于总行程时间。现场时间与运输方式或行程距离无关。这些数据可有助于转诊医院和接收医院以及CCT服务机构规划医疗机构间的转运。威尔科克斯SR、赛亚MS、瓦登H、麦加恩SJ、弗雷克斯M、韦德尔SK、理查兹JB。低氧性呼吸衰竭患者医疗机构间转运的现场时间。院前灾难医学。2016；31(3):267 - 271。
