Timings of pre-hospital life-saving interventions in mass casualty incidents: an observational simulation study.

BACKGROUND

Mass casualty incidents (MCIs) pose significant challenges for pre-hospital care. In particular, there is a tension between the need for rapid triage and the need to deliver life-saving interventions (LSIs). Currently, only the simplest interventions are considered appropriate during triage. However, few data exist on how long it takes to perform LSIs, and there may be a difference between perception and reality. This study aims to determine the time intervals (TIs) to perform key LSIs in a simulated pre-hospital setting, and the differences between estimated and actual TIs.

METHODS

An observational simulation study was conducted over three sessions at two pre-hospital training centers. Pre-hospital care providers (PHCPs) performed 16 LSIs. A pre-intervention questionnaire was used to assess the participants' backgrounds and LSI experience. Non-parametric tests were used to compare TIs between professional groups and evaluate differences between estimated and actual TIs.

RESULTS

Twenty PHCPs participated: eight physicians and 12 paramedics, with a median pre-hospital experience of nine years. TIs for all LSIs were ≤ 130 s, except for rapid sequence induction and intubation (RSI), median 348 s (IQR: 329-366). Team-based LSIs where paramedics and physicians worked together, had prolonged durations for certain steps, with the RSI preparation stage being the longest (59% of total TI). Considerable delays were also observed in the post-placement securing phase (RSI: 43 s, chest tube: 58 s). All PHCPs tended to overestimate how long TIs take, with significant differences noted in supraglottic airway insertion, cricothyroidotomy, needle decompression and finger thoracostomy.

CONCLUSION

We provide data on the time taken for LSIs in a simulated pre-hospital environment. Nearly all LSIs were completed within two minutes, yet PHCPs overestimated the time it takes to perform them. Approaches to the triage process may need to be reviewed in light of these data. There are further opportunities to streamline the delivery of some interventions.