Factors influencing on-scene time in a rural Norwegian helicopter emergency medical service: a retrospective observational study

Abstract

BackgroundCritically ill patients need to be immediately identified, properly managed, and rapidly transported to definitive care. Extensive prehospital times may increase mortality in selected patient groups. The on-scene time is a part of the prehospital interval that can be decreased, as transport times are determined mostly by the distance to the hospital. Identifying factors that affect on-scene time can improve training, protocols, and decision making. Our objectives were to assess on-scene time in the Helicopter Emergency Medical Service (HEMS) in our region and selected factors that may affect it in specific and severe conditions.MethodsThis retrospective cohort study evaluated on-scene time and factors that may affect it for 9757 emergency primary missions by the three HEMSs in western Norway between 2009 and 2013, using graphics and descriptive statistics.ResultsThe overall median on-scene time was 10 minutes (IQR 5–16). The median on-scene time in patients with penetrating torso injuries was 5 minutes (IQR 3–10), whereas in cardiac arrest patients it was 20 minutes (IQR 13–28). Based on multivariate linear regression analysis, the severity of the patient’s condition, advanced interventions performed, mode of transport, and trauma missions increased the on-scene time. Endotracheal intubation increased the OST by almost 10 minutes. Treatment prior to HEMS arrival reduced the on-scene time in patients suffering from acute myocardial infarction.DiscussionWe found a short OST in preselected conditions compared to other studies. For the various patient subgroups, the strength of association between factors and OST varied. The time spent on-scene and its influencing factors were dependent on the patient’s condition. Our results provide a basis for efforts to improve decision making and reduce OST for selected patient groups.ConclusionsThe most important factors associated with increased on-scene time were the severity of the patient’s condition, the need for intubation or intravenous analgesic, helicopter transport, and trauma missions.Electronic supplementary materialThe online version of this article (10.1186/s13049-017-0442-5) contains supplementary material, which is available to authorized users.

Missions of the Helicopter Emergency Medical Service in rural and urban areas in Poland – A comparative retrospective analysis

“…The analysed group of patients consisted mainly of males who made up two-thirds of the entire group, and persons aged 50-64, mean age of the whole group -47.71 years. The results of the authors' own research concerning demographic data of the patients are similar to results obtained by other authors, such as Østerås et al and Kottmann et al [22,23].…”

“…In Sweden, a study carried out by Kornhall et al concerning HEMS missions in rural areas, showed that the main reasons for the missions were injuries, chest pain and sudden cardiac arrest [23]. In Norway, similar results were obtained by Østerås et al in their study concerning HEMS missions [22].…”

“…The study conducted by Kottmann et al in Switzerland concerning HEMS missions to patients with body injuries showed that the clinical status of the patients was mild and moderate (NACA 1-3) [23]. Studies by Kornhall et al concerning HEMS missions in rural areas in Sweden and HEMS missions in Norway conducted by Østerås et al, revealed that the average NACA score was 4 [22,29]. In the study conducted by Newgard et al lower GCS, lower systolic blood pressure, abnormal number of breaths and pulse, were observed more often in patients treated in urban areas [26].…”

Dispatcher Criteria and Therapeutic Measurement by Air Emergency Ambulance of Kurdistan Province, Iran, 2017

“…On-scene-time depends on several factors including type of accident (trauma or cardiac), severity of injury, therapeutic measures (such as fixation, intubation, etc. ), and the patient transportation type [19].…”

“…Regarding the fact that the main reason for transport by HEMS in the current study was trauma, the most taken measures were related to the fixation of various body organs. In some studies conducted in Iran [14,19].…”