Prehospital response model and time to CT scan in blunt trauma @entity1 ; an exploratory analysis of data from the XXXX retrieval trial.

@entity1 @entity341 @entity542 @entity2613
BACKGROUND: It has been suggested that prehospital care teams that can provide advanced prehospital interventions may decrease the transit time through the @entity2613 to CT scan and subsequent surgery. This study is an exploratory analysis of data from the @entity542 Retrieval Trial (HIRT) examining the relationship between prehospital team type and time intervals during the prehospital and @entity2613 phases of management. METHODS: Three prehospital care models were compared; road paramedics, and two physician staffed @entity341 ( @entity341 ) - HIRT @entity341 and the Greater Sydney Area (GSA) @entity341 . Data on prehospital and @entity2613 time intervals for @entity1 who were randomised into the HIRT were extracted from the trial database. Additionally, data on interventions at the scene and in the @entity2613 , plus prehospital entrapment rate was also extracted. Subgroups of @entity1 that were not trapped or who were intubated at the scene were also specifically examined. RESULTS: A total of 3125 incidents were randomised in the trial yielding 505 cases with significant injury that were treated by road paramedics, 302 @entity1 treated by the HIRT @entity341 and 45 @entity1 treated by GSA @entity341 . The total time from emergency call to CT scan was non-significantly faster in the HIRT @entity341 group compared with road paramedics (medians of 1.9 hours vs. 2.1 hours P = 0.43) but the rate of prehospital intubation was 41% higher in the HIRT @entity341 group (46.4% vs. 5.3% P   <   0.001). Most time intervals for the GSA @entity341 were significantly longer with a regression analysis indicating that GSA @entity341 scene times were 13 (95% CI, 7-18) minutes longer than the HIRT @entity341 independent of injury severity, entrapment or interventions performed on scene. CONCLUSION: This study suggests that well-rehearsed and efficient interventions carried out on-scene, by a highly trained physician and paramedic team can allow earlier critical care treatment of severely injured @entity1 without increasing the time elapsed between injury and hospital-based intervention. There is also indication that role specialisation improves time intervals in physician staffed @entity341 which should be confirmed with purpose designed trials.
