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

Abstract

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.

The golden hour of shock – how time is running out: prehospital time intervals in Germany—a multivariate analysis of 15, 103 patients from the TraumaRegister DGU®

“…In accordance with the results of van der Velden, we observed a significant prolongation of the OST when a chest tube was established 25. The major indications for establishing a chest tube in the field are the (suspected) existence of tension pneumothorax or the scheduled transportation by helicopter of patients under positive pressure ventilation.…”

Prehospital endotracheal intubation and chest tubing does not prolong the overall resuscitation time of severely injured patients: a retrospective, multicentre study of the Trauma Registry of the German Society of Trauma Surgery

“…The fact that the overall TRT were far beyond the so-called ‘golden hour’ is also shown in other studies 8 10…”

“…Comparing our results with international analyses our total prehospital TRT was longer than expected 10 24…”

The influence of prehospital time on trauma patients outcome: A systematic review

“…However, because no increased mortality could be demonstrated there is no reason to transport sooner than current protocol in the stay-and-treat group. This demonstrates the idea that interventions performed on-scene and their duration are of great influence on the outcome of a trauma patient [41].…”