On-scene intravenous line insertion adversely impacts prehospital time in XXXX .

@entity1 @entity341 @entity101 @entity130
Fatality rates from @entity130 are almost double those found in urban settings. Increased @entity341 ( @entity341 ) prehospital time has been implicated as one of the causative factors for higher rural fatality rates. Advanced @entity130 Life Support guidelines suggest scene time should not be extended to insert an intravenous catheter (IV). The purpose of this study was to assess the association between intravenous line placement and motor vehicle crash (MVC) scene time in rural and urban settings. An imputational methodology using the National Highway Traffic Safety Administration Crash Outcome Data Evaluation System permitted linkage of data from police motor vehicle crash and @entity341 records. Intergraph GeoMedia software permitted this linked data to be plotted on digital maps for segregation into rural and urban groups. MVCs were defined as rural or urban by location of the accident using the U.S. Bureau of Census Criteria. Linked data were analyzed to assess for @entity341 time on-scene, on-scene IV insertion, on-scene IV insertion attempts, and @entity1 mortality. Over a 2-year period from January 2001 through December 2002, data were collected from Alabama @entity341 @entity1 care reports (PCRs) and police crash reports. A total of 45,763 police crash reports were linked to @entity341 PCRs. Of these linked crash records, 34,341 (75%) and 11,422 (25%) were injured in rural and urban settings, respectively. Six hundred eleven (1.78%) mortalities occurred in rural settings and 103 (0.90%) in urban settings (P < 0.005). There were 6273 (18.3%) on-scene IV insertions in the rural setting and 1,290 (11.3%) in the urban setting (P < 0.005). Mean @entity341 time on-scene when single IV insertion attempts occurred was 16.9 minutes in the rural setting and 14.5 minutes in the urban setting (P < 0.0001). When two attempts of on-scene IV insertion were made, mean @entity341 time on-scene in the rural setting (n = 891 [2.6%]) was 18.4 minutes and 15.7 minutes in the urban setting (n = 142 [1.2%; P < 0.005). Excluding dead on-scene @entity1 , mean @entity341 time on-scene when mortalities occurred in rural and urban settings was 18.9 minutes and 10.8 minutes, respectively (P < 0.005). On-scene IV insertion occurred with significantly greater frequency in rural than urban settings. This incurs greater @entity341 time on-scene and prehospital time that may be associated with @entity101 rates in rural settings.
