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Determinants of On-Scene Time in Injured Patients Treated by Physicians at the Site

Published online by Cambridge University Press:  28 June 2012

John S. Sampalis ,
André Lavoie ,
Maribel Salas ,
Andreas Nikolis  and
Jack I. Williams
John S. Sampalis*
Affiliation:
Department of Surgery, McGill University, Montreal, Québec, Canada Department of Epidemiology and Biostatistics, McGill University, Montreal, Québec, Canada
André Lavoie
Affiliation:
Urgences-Santé, Montreal, Québec, Canada
Maribel Salas
Affiliation:
Department of Epidemiology and Biostatistics, McGill University, Montreal, Québec, Canada
Andreas Nikolis
Affiliation:
Department of Surgery, McGill University, Montreal, Québec, Canada
Jack I. Williams
Affiliation:
Sunnybrook Medical Centre University of Toronto, North York, Ontario, Canada
*
Montreal General Hospital, Division of Clinical Epidemiology, Department of Surgery, 1650 Cedar Ave., Montreal, Québec, Canada H3G 1A4
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Abstract

Introduction:

The controversy surrounding the use of advanced life support (ALS) for the prehospital management of trauma pivots on the fact that these procedures could cause significant and life-threatening delays to definitive in-hospital care.

In Montreal, Québec, on-site ALS to injured patients is provided by physicians only. The purpose of this study was to identify parameters associated with the duration of scene time for patients with moderate to severe injuries treated by physicians at the scene.

Hypothesis:

The use of on-site ALS by physicians is associated with a significant increase in scene time.

Methods:

A total of 576 patients with moderate to severe injuries are included in the analysis. This group was part of a larger cohort used in the prospective evaluation of trauma care in Montreal. Descriptive statistics, analysis of variance, multiple linear regression, and multiple logistic regression techniques were use to analyze the data.

Results:

Use of ALS in general was associated with a statistically significant increase in the mean scene time of 6.5 min. (p = .0001). Significant increases in mean scene time were observed for initiation of an intravenous route (mean = 6.6 min., p = .0001), medication administration (mean =5.7 min., p = .0001), and pneumatic antishock garment (PASG) application (mean = 9.3 min., p = .03). Similar differences were observed for total prehospital time. A significant increase in the relative odds for having long scene times (>20 min.) also was associated with the use of ALS. This level of scene time was associated with a significant increase in the odds of dying (OR = 2.6, p = .009).

Conclusion:

This study shows that physician-provided, on-site ALS causes significant increase in scene time and total prehospital time. These delays are associated with an increase in the risk for death in patients with an severe injuries.

Keywords

advanced life supportintravenous lineson-scene timephysicians on-sitepneumatic antishock garmenttrauma
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 9 , Issue 3 , September 1994 , pp. 178 - 188
Copyright
Copyright © World Association for Disaster and Emergency Medicine 1994

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