Prehospital Response Time of the Emergency Medical Service during Mass Casualty Incidents and the Effect of Triage: A Retrospective Study

Abstract

Objective: Prehospital time affects survival in trauma patients. Mass casualty incidents (MCIs) are overwhelming events where medical care exceeds available resources. This study aimed at evaluating the prehospital time during MCIs and investigating the effect of triage. Methods: A retrospective analysis was performed using Florida’s Event Medical Services Tracking and Reporting System database. All patients involved in MCIs during 2018 were accessed, and prehospital time intervals were evaluated and compared to that of non-MCIs. The effect of MCI triage and field triage (Field Triage Criteria) on prehospital time was evaluated. Results: In 2018, it was estimated that 2236 unique MCIs occurred in Florida, with a crude incidence of 10.1-10.9/100000 people. 2180 EMS units arrived at the hospital for patient disposition with a median alarm-to-hospital time of 43.74 minutes, significantly longer than non-MCIs (39.15 min; P < 0.001). MCI triage and field triage were both associated with shorter alarm-to-hospital time (39.37 min and 37.55 min, respectively). Conclusions: MCIs resulted in longer prehospital time intervals than non-MCIs. This finding suggests that additional efforts are needed to reduce the prehospital time for MCI patients. MCI triage and field triage were both associated with shorter alarm-to-hospital times. Widespread use may improve prehospital MCI care.

Impact of the coronavirus disease 2019 (COVID‐19) pandemic on the operational efficiency of emergency medical services and its association with out‐of‐hospital cardiac arrest survival rates: A population‐based cohort study in Kobe, Japan

“…11 In general, various factors can prolong response time, including time of incidents, road conditions, weather, 12 area of incidents, 13 and the occurrence of mass casualty incidents. 14 During the COVID-19 pandemic period, poor response times were attributed to several factors, including the need for dispatchers to request additional information about potential COVID-19 infections and symptoms when responding to an emergency call, 15 an increase in dispatcher workload due to an increase in emergency calls. [16][17][18] These factors led to an increase in the time interval between emergency call receipt and ambulance assignment.…”

Factors Associated With Delayed Pre-Hospital Times During Trauma-Related Mass Casualty Incidents: A Systematic Review

“…The extended interval from injury time to definitive care is a known detriment associated with poor patient outcomes. 6 Previous pre-hospital studies focused solely on transport timeframes in non-MCI EMS responses. [35][36][37] However, these studies cannot convey the complexity of factors affecting PHTs within an MCI.…”

“…An extended pre-hospital period is associated with increased mortality rates, and contemporary trauma systems strive to reduce PHT to improve patient outcomes. 4–6…”

“…An extended pre-hospital period is associated with increased mortality rates, and contemporary trauma systems strive to reduce PHT to improve patient outcomes. [4][5][6] There is a lack of consensus about whether "scoop and run" (transporting patients as quickly as possible) or "stay and play" (stabilizing patients and initiating advanced treatment on scene) is most advantageous for patient outcomes. 7 Total PHT encompasses sequential intervals including pre-alarm, response, on-scene, and transport time.…”