1.Emergency Medical Retrieval Service,SAAS MedSTAR,Adelaide, South Australia,Australia.
Prehosp Disaster Med. 2019 Jun;34(3):317-321. doi: 10.1017/S1049023X19004394.
Prehospital physicians balance the need to stabilize patients prior to transport, minimizing the delay to transport patients to the appropriate level of care. Literature has focused on which interventions should be performed in the prehospital environment, with airway management, specifically prehospital intubation (PHI), being a commonly discussed topic. However, few studies have sought additional factors which influence scene time or quantify the impact of mission characteristics or therapeutic interventions on scene time.Hypothesis/Problem:The goal of this study was to identify specific interventions, patient demographics, or mission characteristics that increase scene time and quantify their impact on scene time.
A retrospective, database model-building study was performed using the prehospital mission database of South Australian Ambulance Service (SAAS; Adelaide, South Australia) MedSTAR retrieval service from January 1, 2015 through August 31, 2016. Mission variables, including patient age, weight, gender, retrieval platform, physician type, PHI, arterial line placement, central line placement, and finger thoracostomy, were assessed for predictors of scene time.
A total of 506 missions were included in this study. Average prehospital scene time was 34 (SD = 21) minutes. Four mission variables significantly increased scene time: patient age, rotary wing transport, PHI, and arterial line placement increased scene time by 0.09 (SD = 0.08) minutes, 13.6 (SD = 3.2) minutes, 11.6 (SD = 3.8) minutes, and 34.4 (SD = 8.4) minutes, respectively.
This study identifies two mission characteristics, patient age and rotary wing transport, and two interventions, PHI and arterial line placement, which significantly increase scene time. Elderly patients are medically complex and more severely injured than younger patients, thus, may require more time to stabilize on-scene. Inherent in rotary wing operations is the time to prepare for the flight, which is shorter during ground transport. The time required to safely execute a PHI is similar to that in the literature and has remained constant over the past two years; arterial line placement took longer than envisioned. The SAAS MedSTAR has changed its clinical practice guidelines for prehospital interventions based on this study's results. Retrieval services should similarly assess the necessity and efficiency of interventions to optimize scene time, knowing that the time required to safely execute an intervention may reach a minimum duration. Defining the scene time enables mission planning, team training, and audit review with the aim of improved patient care.
院前医生需要平衡在转运前稳定患者的需求，同时尽量减少将患者转运至适当治疗级别的时间延迟。文献主要集中于探讨应在院前环境中进行哪些干预措施，其中气道管理，特别是院前插管（PHI），是一个经常讨论的话题。然而，很少有研究关注影响现场时间的其他因素，或量化任务特征或治疗干预对现场时间的影响。
假设/问题：本研究的目的是确定增加现场时间的具体干预措施、患者人口统计学特征或任务特征，并量化它们对现场时间的影响。
这是一项使用南澳大利亚救护服务（SAAS；阿德莱德，南澳大利亚）MedSTAR 检索服务的院前任务数据库进行的回顾性数据库建模研究，研究时间为 2015 年 1 月 1 日至 2016 年 8 月 31 日。对任务变量（包括患者年龄、体重、性别、检索平台、医生类型、PHI、动脉置管、中心静脉置管和手指胸腔穿刺术）进行评估，以确定与现场时间相关的预测因素。
本研究共纳入 506 项任务。平均院前现场时间为 34（SD=21）分钟。有 4 项任务变量显著增加了现场时间：患者年龄、直升机转运、PHI 和动脉置管分别使现场时间增加 0.09（SD=0.08）分钟、13.6（SD=3.2）分钟、11.6（SD=3.8）分钟和 34.4（SD=8.4）分钟。
本研究确定了两个任务特征（患者年龄和直升机转运）和两个干预措施（PHI 和动脉置管），它们显著增加了现场时间。老年患者的病情比年轻患者更复杂，病情更严重，因此可能需要更多的时间在现场稳定病情。直升机作业的固有特点是为飞行做准备的时间，这比地面运输短。执行 PHI 所需的时间与文献中的时间相似，并且在过去两年中保持不变；动脉置管所需的时间比预期的要长。南澳大利亚救护服务根据本研究的结果修改了院前干预措施的临床实践指南。检索服务也应评估干预措施的必要性和效率，以优化现场时间，因为安全执行干预措施所需的时间可能达到最短时间。确定现场时间可用于任务规划、团队培训和审核审查，以提高患者护理质量。
