Written by Andy Hogan
In the prehospital setting, prolonged on-scene times were associated with increased 24-hour and 30-day mortality for moderately or severely injured, undifferentiated trauma patients.
Why does this matter?
For many trauma patients, prehospital clinicians and medical directors must weigh the benefits of field resuscitation against the significant increase in mortality associated with every minute spent on scene. What difference does on-scene time make?
The trauma clock is ticking…
Prehospital clinicians must frequently decide between on-scene resuscitation (“stay and play”) and rapid transport to definitive care (“scoop and run”). Both philosophies have merit at times—on-scene needle decompression may be lifesaving, while a ruptured spleen needs an OR, STAT. This large, observational study examined the impact of prolonged prehospital time on 24-hour and 30-day mortality in 25,535 undifferentiated, moderately or severely injured (Injury Severity Score ≥9) trauma patients. After robust adjustment for confounders, the authors reported a significant association between each additional minute on scene and both 24-hour (RR 1.029) and 30-day (RR 1.013) mortality. Framed differently, a 10-minute delay on scene beyond the expected time needed to load a trauma patient increased a patient’s risk of dying at 24-hours by 33%. The study also reported increased 24-hour (1.797) and 30-day (1.298) mortality for on-scene times ≥20 minutes. Interestingly, the study did not detect an association between transport times and mortality outcomes. These findings seem to both support the “scoop and run” model for trauma patients and validate selective transport to a leveled trauma center. This study, however, did not explore the many variables that contribute to longer on-scene times. For example, prolonged extrication after a traffic accident might unavoidably delay transport. Additionally, the impact of prehospital interventions was not explored. Achieving hemorrhage control and initiating blood transfusion may justify a longer scene time for an exsanguinating patient. Nevertheless, this study reinforces the importance of minimizing excessive on-scene times and models well-designed statistical techniques for future research.
The impact of prehospital time intervals on mortality in moderately and severely injured patients. J Trauma Acute Care Surg. 2022;92(3):520-527. doi:10.1097/TA.0000000000003380