Online Program

Impact of Prehospital Times on Major In-hospital Complication after Trauma

Tuesday, November 3, 2015 : 5:15 p.m. - 5:30 p.m.

Teresa Bell, PhD, Surgery, Indiana University School of Medicine, Indianapolis, IN
Peter Jenkins, MD, MPH, Surgery, Indiana University School of Medicine, Indianapolis, IN
Alison Fecher, MD, Surgery, Indiana University School of Medicine, Indianapolis, IN
Ben Zarzaur Jr., MD, MPH, Surgery, Indiana University School of Medicine, Indianapolis, IN
Background: Due to the fragility of critically injured patients, the timeliness of prehospital care plays a crucial role not only in increasing survival but also in reducing the likelihood of complications and improving functional outcomes. The objective of this study was to determine the effect of emergency medical service (EMS) response and scene times on the likelihood of experiencing a major in-hospital complication after trauma.

Methods: We performed a retrospective cohort study that analyzed patient records included in the National Trauma Data Bank (NTDB) from years 2008-2010. Multilevel modeling was used to assess the relationship between EMS times and in-hospital complication. Complications included acute respiratory distress, acute renal failure, cardiac arrest, myocardial infarction, stroke, pulmonary embolism, surgical site infection, pneumonia, and sepsis. Models controlled for age, sex, race/ethnicity, comorbidities, insurance, injury severity, hypotension, mechanism of injury, head injury, and hospital clustering.

Results: Longer EMS response times were predictive of complication (reference=10 minutes or less; 11-20 minutes OR=1.10[CI:1.04,1.17]; 21-30 minutes OR=1.13[CI:1.05,1.22]; 31-40 minutes OR=1.07 [CI:0.96,1.19]; 41-50 minutes OR=1.06[CI:0.90, 1.24]; over 50 minutes OR=1.17[CI:1.02,1.34]). EMS Scene times were predictive of complications, but not in a linear fashion (reference=10 minutes or less; 11-20 minutes OR=0.92[CI:0.86,0.97]; 21-30 minutes OR=0.98[CI:0.91,1.05]; 31-40 OR=0.97[CI:0.88,1.07]; 41-50 minutes OR=1.22[CI:1.08,1.38]; over 51 minutes OR=1.20[CI:1.06,1.35]).

Conclusion: Our results suggest that shorter EMS response times are associated with reduced likelihood of experiencing a major in-hospital complication. The relationship between EMS scene times and complication is less clear, with patients spending 10-20 minutes on the scene being the least likely to experience complications.

Learning Areas:

Provision of health care to the public
Public health administration or related administration

Learning Objectives:
Describe how EMS response and scene times impact the likelihood of experiencing major in-hospital complications after trauma.

Keyword(s): Emergency Medical Services, Outcomes Research

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I received a PhD in health outcomes and policy research in May 2014. I have worked in injury research for the past 5 years.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 4425.0: Emergency Medical Services