![]() ![]() Time from arrival on scene to “patient contact” was not reliably available. Variables included the following: EMS agency patient age, gender, race, and ethnicity encounter year primary and secondary impression EMS on-scene time EMS scene departure time urbanicity defined either as urban or rural and trauma center arrival time. We collated each agency’s data into a single report for analysis. ![]() The extractors did not alter the raw data. They were provided with a standardized, pilot-tested data extraction report to be run through their EMR system. These EMS representatives were blinded to the specific aims of the study. An EMS agency representative in each county extracted the data. Each county operates its own single-tier, ALS-level EMS agency that receives medical direction from emergency physicians with subspecialty board certification in EMS.Įach agency uses the same prehospital electronic medical record system (ESO Solutions, Austin, TX,). The EMS agencies serve a combined population of nearly 700,000 people and transport to two American College of Surgeons (ACS)-verified Level I trauma centers and one ACS-verified Level II trauma center. Two of the five study counties have robust urban centers with approximately 250,000 people each, while the remaining three counties are largely suburban and rural communities. This study was conducted across five counties with Advanced Life Support (ALS) EMS agencies over a five-year period (January 1, 2013–January 1, 2018) in a mixed urban and rural area of NC. The purpose of this study was to examine prehospital time patterns to better understand scene and transport time practices among patients with blunt or penetrating trauma. To date, no literature specifically compares prehospital time intervals of adult to pediatric trauma patients. 7, 8 While well studied in the adult population, the role of the golden hour in pediatric trauma is unclear. 7, 8 Prehospital professionals are generally expected to keep trauma scene times under 10 minutes and may transport patients using emergency lights and sirens to reduce total out-of-hospital time. Owing to this, an emphasis on limiting prehospital time permeates EMS care systems. 13 This body of literature supports the golden hour principle. 12 Feero et al examined nearly 1000 trauma registry cases in Oregon and concluded that less out-of-hospital time was associated with increased survival. They found that out-of-hospital time in excess of 60 minutes was associated with a three-fold increase in mortality. 20 In a separate study, Sampalis et al performed a case-control multivariable logistic regression analysis of 360 trauma patients. In a logistic regression model, they found that prolonged scene time was associated with increased mortality among patients with hypotension, penetrating trauma, and flail chest. 12 Brown et al examined 164,000 trauma registry cases. Sampalis et al suggest that for each additional minute of prehospital time, the risk of dying increases by 5%. He wrote, albeit anecdotally at the time, that “the first hour after injury will largely determine a critically-injured person’s chances for survival.” 10 Multiple research studies support the concept that less time to definitive care results in better patient outcomes, 6, 12 – 14 particularly with certain disease states, such as severe head injury, 15, 16 abdominal injury, 17 and thoracic injury. Adams Cowley, the physician who founded Baltimore’s Shock Trauma Institute. 9, 10 The golden hour concept is primarily attributed to R. 7 – 11 The golden hour is well-known to EMS providers and directs them to deliver trauma patients to definitive care within 60 minutes of injury. In caring for trauma patients, out-of-hospital time is an important factor in patient outcomes. 5, 6 EMS is tasked with providing prehospital emergency care and with transporting patients to definitive care. 3, 4 Owing to the significant burden of disease, the US maintains a robust trauma care infrastructure, including trauma centers, trauma prevention programs, and emergency medical services (EMS). 1, 2 It accounts for 60% of deaths in patients less than 20 years old. Trauma is the leading cause of death in the United States (US) for individuals under 45 years of age. ![]()
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