Emergency Medical Services
Background: Extended prehospital trauma scene times are associated with adverse patient outcomes. Limited data exist comparing pediatric to adult scene time management. The objectives of this study are to compare prehospital scene time for pediatric and adult trauma patients and to identify factors that influence trauma scene times.
Method: We performed a retrospective cohort study of blunt and penetrating trauma patients in a five-county region from 2013 to 2018. Patients were transported emergency traffic from the scene by ground ambulance to a Level I or Level II certified trauma center. The prehospital electronic medical record was queried for patient demographics, mechanism of injury, scene time, and the county-based EMS agency that provided care. Pediatric patients were less than 16 years old and adult patients were 16 years old or greater. Parametric univariate analyses and linear regression modeling were performed.
Results: There were 2090 patients, with 92% (n=1931) adult and 8% (n=159) pediatric. Blunt injury accounted for 81% (n=1685) and penetrating injury 19% (n=405). Mean adult blunt trauma scene time (15.6 minutes, 95%CI 15.3-16.0) was significantly greater than mean pediatric blunt trauma scene time (12.7, 95%CI 11.7-13.8). Mean adult penetrating trauma scene time (9.5 minutes, 95%CI 9.0-10.) was significantly greater than mean penetrating trauma scene time (5.6, 95%CI 4.6-7.2). Linear regression controlling for age, mechanism of injury, EMS agency, sex, and race revealed that pediatric patients had shorter scene time than adults by 2.7 minutes (p<.0001), penetrating injury had shorter scene time than blunt injury by 5.1 minutes (p<.0001), males had shorter scene time than females by 1.0 minutes (p=.0009), African American patients were on scene 0.8 minutes less than White patients (p=.03), and that EMS agency had a significant impact on scene time (p<.0001).
Conclusion: Scene time was shorter for pediatric patients, penetrating trauma, males, and African American patients. Identifying factors that prolong scene time and addressing systemic biases will enable prehospital providers to work towards consistent scene management practices with the goal of improving patient outcomes.