The importance of access-to-patient-period in the emergency service.

The "period-to-help" (Hilfsfrist) is defined by the federal states as a measure for further planning and structure the emergency services. This period is composed of distinct time intervals and ends with the arrival of the rescue team at the emergency. From a physician's point of view it is merely the time to the first contact with the patient that is of vital interest. Data on the discrepancy between arrival at the emergency scene and the first contact with the patient are lakking. Methods: We analysed prospectively 680 emergencies outside the hospital and calculated the so-called "access-to-patient" period (Zugangszeit). 552 emergencies supplied with an ambulance and 128 emergencies supplied with a helicopter ambulance service were analysed. Results: The mean total time period for the ambulance arriving at the patient was 8.17 minutes+/-30.3 seconds while being 10.52 minutes+/-73.3 seconds for the helicopter ambulance service. The "access-to-patient" period was 50.9 minutes+/-8.2 seconds for the ambulance and 75.7 minutes+/-21.7 seconds for the helicopter ambulance service. For road accidents the "access-to-patient" period was significantly shorter for both the ambulance (12.4+/-4.1 seconds) and the helicopter (19.6+/-10.8 seconds), while in emergencies taking place inside closed buildings these time intervals were 5 and 6.5 times longer (ambulance 64.2+/-10.9 seconds). As outer circumstances counted most to prolonged access-to-patient periods the latter did not correlate with the severity of the injury or the emergency. Appropriate guidance and briefing of the crew of an emergency service at the scene is able to minimize the access-to-patient period (74.5 versus 60.4 seconds for the ambulance and the helicopter, respectively). Delays were caused in 22.6% of all emergencies, mostly due to imprecise orders, impassable terrain and the inability to identify the building. Conclusion: If we consider that road accidents count for merely 10% of all emergencies it seems appropriate to re-define the so-called "period-to-help" (Hilfsfrist) that takes into account the "access-to-patient" period (Zugangszeit) that is on average 50 seconds. The primary goal of any further planning must be to keep the interval without sufficient therapy as short as possible.