Selected Topics : Prehospital Care EIGHT MINUTES OR LESS : DOES THE AMBULANCE RESPONSE TIME GUIDELINE IMPACT TRAUMA PATIENT OUTCOME ?

Emergency Medical Services (EMS) agencies are increasingly being held to an ambulance response time (RT) criterion of responding to a medical emergency within 8 min for at least 90% of calls. This recommendation resulted from one study of outcome after nontraumatic cardiac arrest and has never been studied for any other emergency. This retrospective study evaluates the effect of exceeding the 8 min RT guideline on patient survival for victims of traumatic injury treated by an urban paramedic ambulance EMS system and transported to a single Level I trauma center. Of 3576 patients identified by the hospital trauma registry, 3490 (97.6%) had complete records available. Patients were grouped according to ambulance RT: < or = 8 min (n = 2450) or > 8 min (n = 1040). After controlling for other significant predictors, there was no difference in survival after traumatic injury when the 8 min ambulance RT criteria was exceeded (mortality odds ratio 0.81, 95% CI 0.43-1.52). There was also no significant difference in survival when patients were stratified by injury severity score group. Exceeding the ambulance industry response time criterion of 8 min does not affect patient survival after traumatic injury.

[1]  B. Rowe,et al.  Cardiac arrest in Ontario: circumstances, community response, role of prehospital defibrillation and predictors of survival. , 1992, CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne.

[2]  D K McKenas,et al.  Use of automated external defibrillators by a U.S. airline. , 2000, The New England journal of medicine.

[3]  P E Pepe,et al.  The relationship between total prehospital time and outcome in hypotensive victims of penetrating injuries. , 1987, Annals of emergency medicine.

[4]  M. Callaham,et al.  Relationship of timeliness of paramedic advanced life support interventions to outcome in out-of-hospital cardiac arrest treated by first responders with defibrillators. , 1996, Annals of emergency medicine.

[5]  J R Mateer,et al.  EMT-defibrillation: the Wisconsin experience. , 1989, Annals of emergency medicine.

[6]  J. Sampalis,et al.  Advanced or basic life support for trauma: meta-analysis and critical review of the literature. , 2000, The Journal of trauma.

[7]  A. Detsky,et al.  Effectiveness of emergency medical services for victims of out-of-hospital cardiac arrest: a metaanalysis. , 1996, Annals of emergency medicine.

[8]  A. Hallstrom,et al.  Cardiac Resuscitation in the Community , 1979 .

[9]  P. Paris,et al.  Use of automated external defibrillators by police officers for treatment of out-of-hospital cardiac arrest. , 1998, Annals of emergency medicine.

[10]  R A Narad,et al.  Regulation of ambulance response times in California. , 1999, Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors.

[11]  H W Meislin,et al.  Prospective validation of a new model for evaluating emergency medical services systems by in-field observation of specific time intervals in prehospital care. , 1993, Annals of emergency medicine.

[12]  R. V. van Hoeyweghen,et al.  Influence of time intervals on outcome of CPR. The Cerebral Resuscitation Study Group. , 1989, Resuscitation.

[13]  C. Ho,et al.  Response times and outcomes for cardiac arrests in Las Vegas casinos. , 1998, The American journal of emergency medicine.

[14]  R. Roberge,et al.  Penetrating thoracic injuries: in-field stabilization vs. prompt transport. , 1987, The Journal of trauma.

[15]  H. Reines,et al.  Resuscitative thoracotomy: the effect of field time on outcome. , 1988, The Journal of trauma.

[16]  J. Müller,et al.  [Penetrating thoracic injuries]. , 1992, Unfallchirurgie.

[17]  G Bentham,et al.  Emergency medical service accessibility and outcome from road traffic accidents. , 1995, Public health.

[18]  R. Stewart,et al.  Out-of-hospital cardiac arrest: factors associated with survival. , 1984, Annals of emergency medicine.

[19]  M. Copass,et al.  Considerations for improving survival from out-of-hospital cardiac arrest. , 1986, Annals of emergency medicine.

[20]  M. O’Gorman,et al.  Zero-time prehospital i.v. , 1989, The Journal of trauma.

[21]  M. Copass,et al.  Influence of cardiopulmonary resuscitation prior to defibrillation in patients with out-of-hospital ventricular fibrillation , 1999, JAMA.

[22]  M. Copass,et al.  Use of the automatic external defibrillator in the management of out-of-hospital cardiac arrest. , 1988, The New England journal of medicine.

[23]  R. Fischer,et al.  The importance of prompt transport of salvage of patients with penetrating heart wounds. , 1982, The Journal of trauma.

[24]  R. Reynolds-Haertle,et al.  Cardiac arrest and resuscitation: a tale of 29 cities. , 1990, Annals of emergency medicine.

[25]  H. Meislin,et al.  The impact of injury severity and prehospital procedures on scene time in victims of major trauma. , 1991, Annals of emergency medicine.

[26]  N. Dean,et al.  Effect of mobile paramedic units on outcome in patients with myocardial infarction. , 1988, Annals of emergency medicine.

[27]  A. Laupacis,et al.  A cumulative meta-analysis of the effectiveness of defibrillator-capable emergency medical services for victims of out-of-hospital cardiac arrest. , 1999, Annals of emergency medicine.

[28]  J. Ruskin,et al.  Out-of-hospital cardiac arrest: electrophysiologic observations and selection of long-term antiarrhythmic therapy. , 1980, The New England journal of medicine.

[29]  I. Stiell,et al.  Improved Out-of-Hospital Cardiac Arrest Survival Through the Inexpensive Optimization of an Existing Defibrillation Program: OPALS Study Phase II , 1999 .

[30]  D J Roe,et al.  Estimating effectiveness of cardiac arrest interventions: a logistic regression survival model. , 1997, Circulation.

[31]  Lark,et al.  OUTCOMES OF RAPID DEFIBRILLATION BY SECURITY OFFICERS AFTER CARDIAC ARREST IN CASINOS , 2000 .

[32]  Roger D. White,et al.  High discharge survival rate after out-of-hospital ventricular fibrillation with rapid defibrillation by police and paramedics. , 1996, Annals of emergency medicine.

[33]  F. Purdie Cardiac resuscitation in the community: importance of rapid provision and implications for program planning , 1980 .