Garner Alan A, Scognamiglio Andrew, Kamarova Sviatlana
Nepean Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.
Trauma Department, Nepean Hospital, Sydney, New South Wales, Australia.
Emerg Med Australas. 2025 Feb;37(1):e14508. doi: 10.1111/1742-6723.14508. Epub 2024 Oct 2.
A 45-min interval from injury to intubation has been proposed as a performance indicator for severe trauma patient management. In the Sydney pre-hospital system a previous change in case identification systems was associated with activation delay. We aimed to determine if this also decreased the proportion of patients intubated within this benchmark.
Retrospective cohort study of patients intubated by a helicopter emergency medical service (HEMS) over two time periods. Period 1 dispatch was via HEMS crew directly screening the computerised dispatch system, and period 2 was via paramedics in a central control room. Times from emergency call to intubation were compared.
In the HEMS crew screening period 46/58 (79.31%) intubations met the target, compared with 137/314 (43.6%) in the central control period (P < 0.001). The median (interquartile range) time to intubation in the direct crew screening period was 33 (25-41) min, versus the central control period at 47 (38-60) min (P < 0.001). On multivariate modelling, distance to the scene was related to time to intubation (P < 0.001; Incident Rate Ratio = 1.018, 95% confidence interval 1.015-1.020) as was dispatch system, entrapment/access difficulty and indication for intubation (all P < 0.001).
Time from emergency call to intubation was significantly shorter in the HEMS screening period where all non-trapped cases less than 50 km distant were intubated within the 45-min benchmark. There was no distance where intubation within 45 min could be assured for non-trapped patients in the central control period due to dispatch delays.
提出从受伤到插管间隔45分钟作为严重创伤患者管理的一项绩效指标。在悉尼院前系统中，之前病例识别系统的变更与启动延迟有关。我们旨在确定这是否也降低了在此基准时间内插管患者的比例。
对直升机紧急医疗服务（HEMS）在两个时间段内插管的患者进行回顾性队列研究。第1阶段调度是通过HEMS机组人员直接筛查计算机化调度系统，第2阶段是通过中央控制室的护理人员进行调度。比较了从紧急呼叫到插管的时间。
在HEMS机组人员筛查阶段，46/58（79.31%）例插管达到目标，而在中央控制室阶段为137/314（43.6%）（P＜0.001）。直接机组人员筛查阶段插管的中位（四分位间距）时间为33（25 - 41）分钟，而中央控制室阶段为47（38 - 60）分钟（P＜0.001）。在多变量建模中，到现场的距离与插管时间相关（P＜0.001；发生率比 = 1.018，95%置信区间1.015 - 1.020），调度系统、被困/进入困难情况以及插管指征也与之相关（均P＜0.001）。
在HEMS筛查阶段，从紧急呼叫到插管的时间显著更短，在此阶段，所有距离小于50公里且未被困的病例均在45分钟基准时间内完成插管。在中央控制室阶段，由于调度延迟，无法确保任何距离的未被困患者能在45分钟内完成插管。
