Prehospital interventions: time wasted or time saved? An observational cohort study of management in initial trauma care

Objective: Preclinical actions in the primary assessment of victims of blunt trauma may prolong the time to definitive clinical care. The aim of this study was to examine the duration of performed interventions and to study the effect of on-scene time (OST) and interventions performed before admission to hospital on hospital resuscitation time. Methods: 147 consecutive patients with high-energy blunt trauma aged >= 15 years were studied prospectively. Prehospital time intervals and interventions were documented and compared with hospital data collected from continuous digital video registration. Analyses were performed with correction for injury severity and type of prehospital medical assistance ( emergency medical services ( EMS) versus physician-staffed helicopter emergency medical services ( HEMS)). Results: Primary survey and initial treatment were initiated and completed within 1 h of arrival of the EMS. 83% of this "golden hour'' elapsed out of hospital and 81% ( n=224) of all interventions (n=275) were carried out before admission to hospital. An increase in the number of prehospital interventions was associated with an increased OST (p < 0.001). Subanalyses showed no such correlation in the HEMS group. The HEMS group had a longer mean OST than the EMS group ( p, 0.001) with relatively more prehospital interventions ( p < 0.001) and a shorter mean in-hospital primary survey time with fewer in-hospital interventions. Overall, OST and the number of prehospital interventions were not related to in-hospital primary survey time and interventions. Conclusion: For most trauma patients the initial life-and limb-saving care is achieved within the "golden hour''. Prehospital treatment occupies most of the golden hour. More prehospital interventions were performed with HEMS than with EMS only, but the higher number of interventions did not result in a longer OST with HEMS. Although the numbers of subsequent in-hospital interventions may be lower, no reduction in time in hospital may be expected from the interventions performed before hospital admission.