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Prehosp Emerg Care. 2008 Jul-Sep;12(3):327-32. doi: 10.1080/10903120802096928.

The time cost of prehospital intubation and intravenous access in trauma patients.

Author information

1
Robert Wood Johnson Clinical Scholars Program, Department of Emergency Medicine, University of Pennsylvania School of Medicine, and the Center for Outcomes Research at the Children's Hospital of Philadelphia, PA 19104-6021, USA. brendan.carr@uphs.upenn.edu

Abstract

OBJECTIVES:

The prehospital management of trauma patients remains controversial. Little is known about the time each procedure contributes to the on-scene duration, and this information would be helpful in prioritizing which procedures to perform in the prehospital setting. We sought to estimate the contribution of procedures to on-scene duration focusing on intubation and establishment of intravenous (IV) access.

METHODS:

Data were provided by the Office of Emergency Planning and Response at the Mississippi Department of Health. Real-time prehospital patient-level data are collected by emergency medical services (EMS) providers for all 9-1-1 calls statewide. Linear regression was performed to determine the overall additional time for an average procedure and to calculate marginal increases in on-scene time associated with the establishment of IV access and with endotracheal intubation. Analyses were performed using Stata 9.

RESULTS:

During 2001-2005, 192,055 prehospital runs were made for trauma patients. 121,495 (63%) included prehospital procedures. Average on-scene duration for those runs was 15:24 (minutes:seconds). On average, each procedure was associated with an addition of 1 minute to the on-scene duration (95% confidence interval [CI]: 58-62 seconds). A scene involving the establishment of IV access was 5:04 longer, while one involving tracheal intubation was 2:36 longer.

CONCLUSIONS:

We estimate the marginal increase in on-scene duration associated with the performance of an average procedure, establishment of IV access, and endotracheal intubation. There are policy and planning implications for the time trade-off of prehospital procedures, especially discretionary ones.

PMID:
18584500
DOI:
10.1080/10903120802096928
[Indexed for MEDLINE]

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