Prehospital Care Times and Interventions for Victims of Major Trauma in the Central Region of Portugal: A Retrospective Study
DOI:
https://doi.org/10.20344/amp.20983Keywords:
Advanced Trauma Life Support Care, Emergency Medical Services, Emergency Medicine, Time Factors, Transportation of Patients, Wounds and InjuriesAbstract
Introduction: The quality and promptness of prehospital care for major trauma patients are vital in order to lower their high mortality rate. However, the effectiveness of this response in Portugal is unknown. The objective of this study was to analyze response times and interventions for major trauma patients in the central region of Portugal.
Methods: This was a retrospective, descriptive study, using the 2022 clinical records of the National Institute of Medical Emergency’s differentiated resources. Cases of death prior to arrival at the hospital and other non-transport situations were excluded. Five-time intervals were determined, among which are the response time (T1, between activation and arrival at the scene), on-scene time (T2), and transportation time (T5; between the decision to transport and arrival at the emergency service). For each ambulance type, averages and dispersion times were calculated, as well as the proportion of cases in which the nationally and internationally recommended times were met. The frequency of recording six key interventions was also assessed.
Results: Of the 3366 records, 602 were eliminated (384 due to death), resulting in 2764 cases: nurse-technician ambulance (SIV) = 36.0%, physician- nurse ambulance (VMER) = 62.2% and physician-nurse helicopter = 1.8%. In a very large number of records, it was not possible to determine prehospital care times: for example, transport time (T5) could be determined in only 29%, 13% and 8% of cases, respectively for SIV, VMER and helicopter. The recommended time for stabilization (T2 ≤ 20 min) was met in 19.8% (SIV), 36.5% (VMER) and 18.2% (helicopter). Time to hospital (T5 ≤ 45 min) was achieved in 80.0% (SIV), 93.1% (VMER) and 75.0% (helicopter) of the records. The administration of analgesia (42% in SIV) and measures to prevent hypothermia (23.5% in SIV) were the most recorded interventions.
Conclusion: There was substantial missing data on statuses and a lack of information in the records, especially in the VMER and helicopter. According to the records, the time taken to stabilize the victim on-scene often exceeded the recommendations, while the time taken to transport them to the hospital tended to be within the recommendations.
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References
National Association of Emergency Medical Technicians. PHTLS: Prehospital trauma life support. 10.a ed. Burlington: Jones & Bartlett Publishers; 2023.
Colégio de Medicina Intensiva da Ordem dos Médicos, Sociedade Portuguesa de Cuidados Intensivos. Transporte de doentes críticos adultos: recomendações 2023. 2023. [consultado 2022 dez 15]. Disponível em: https://ordemdosmedicos.pt/wp-content/uploads/2023/04/Transporte-Doente-Critico-2023-Versa%CC%83o-CEMI_OM-III-2023.pdf.
American College of Surgeons. Advanced trauma life support (ATLS). 10.a ed. Chicago: American College of Surgeons; 2018.
Mota AC. Transição para a vida laboral após traumatismo crânio- encefálico. Escola Superior de Enfermagem de Lisboa; 2017. [consultado 2023 abr 20]. Disponível em: https://comum.rcaap. pt/bitstream/10400.26/20998/1/Relat%c3%b3rio%20de%20 est%c3%a1gio%20final.pdf.
Barros F, Lucas M. Relatório processos assistências. Instituto Nacional de Emergência Médica. Lisboa: INEM; 2022.
Instituto Nacional de Emergência Médica. Sistema Integrado de emergência médica. Versão 2.0, 1.a ed. 2013. [consultado 2022 out 10]. Disponível em: https://www.inem.pt/wp-content/uploads/2017/06/ Sistema-Integrado-de-Emerg%C3%AAncia-M%C3%A9dica.pdf.
Medrano NW, Villarreal CL, Mann NC, Price AM, Nolte KB, Mackenzie EJ, et al. Activation and on-scene intervals for severe trauma EMS interventions: an analysis of the NEMSOS database. Prehosp Emerg Care. 2023;27:46-53. DOI: https://doi.org/10.1080/10903127.2022.2053615
Carr BG, Caplan JM, Pryor JP, Branas CC. A meta-analysis of prehospital care times for trauma. Prehosp Emerg Care. 2006;10:198-206. DOI: https://doi.org/10.1080/10903120500541324
Harmesen AM, Giannakopoulos GF, Moerbeek PR, Jansma EP, Bonjer HJ, Bloemers FW. The influence of prehospital time on trauma patients outcome: a systematic review. Injury. 2015;46:602-9. DOI: https://doi.org/10.1016/j.injury.2015.01.008
Karagholi AJ, Shafipour V, Yazdani-Charati J, Moghasemi MJ, Yegane SA, Heidarigorji MA. Prehospital emergency response time index for trauma victims in Iran. J Nurs Midwifery Sci. 2023;10:1-8.
Direção-Geral da Saúde. Despacho normativo n.o 012/2022 Via verde do trauma no adulto. 2022. [consultado 2022 dez 01]. Disponível em: https://normas.dgs.min-saude.pt/wp-content/uploads/2023/03/ norma_012_2022_via-verde-do-trauma-no-adulto.pdf.
Direção-Geral da Saúde. Despacho normativo n.o 07/DQS/ DQCO Organização dos cuidados hospitalares urgente ao doente traumatizados. 2010. [consultado 2022 dez 01]. Disponível em: https:// www.dgs.pt/directrizes-da-dgs/normas-e-circulares-normativas/circular- normativa-n-07dqsdqco-de-31032010-pdf.aspx.
Grupo de Trabalho de Trauma da Ordem dos Médicos. Normas de boa prática em trauma. 2009. [consultado 2022 dez 01]. Disponível em: https://ordemdosmedicos.pt/wp-content/uploads/2017/09/Normas_de_ Boa_Pratica_em_Trauma.pdf.
Ministério da Saúde. Relatório anual - acesso a cuidados de saúde nos estabelecimentos do SNS e entidades convencionadas em 2020. 2020 [consultado 2022 dez 15]. Disponível em: https://www.acss.min-saude. pt/wpcontent/uploads/2021/09/Relatorio-do-Acesso_VF.pdf.
National Institute for Health and Care Excellence. Major trauma: service delivery, NICE guideline. 2016. [consultado 2022 dez 01]. Disponível em: https://www.nice.org.uk/guidance/ng40/resources/major-trauma- service-delivery-pdf-1837446110917.
von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol. 2008;61:344-9. DOI: https://doi.org/10.1016/j.jclinepi.2007.11.008
Spahn DR, Bouillon B, Cerny V, Duranteau J, Filipescu D, Hunt BJ, et al. The European guideline on management of major bleeding and coagulopathy following trauma: sixth edition. Crit Care. 2023;23:1-74. DOI: https://doi.org/10.1186/s13054-019-2347-3
Alvarez BD, Razente DM, Lacerda DA, Lother NS, Von-Bahten LC, Stahlschmidt CM. Analysis of the Revised Trauma Score (RTS) in 200 victims of different trauma mechanisms. Rev Col Bras Cir. 2016;43:334- 40. DOI: https://doi.org/10.1590/0100-69912016005010
Mota MA, Santos MR, Santos EJ, Henriques C, Matos A, Cunha M. Trauma prehospital hypothermia prevention and treatment: an observational study. J Trauma Nurs. 2021;28:194-202. DOI: https://doi.org/10.1097/JTN.0000000000000583
Wandling MW, Nathens AB, Shapiro MB, Haut ER. Association of prehospital mode of transport with mortality in penetrating trauma: a trauma system–level assessment of private vehicle transportation vs ground emergency medical services. JAMA Surg. 2018;153:107-13. DOI: https://doi.org/10.1001/jamasurg.2017.3601
Barreira IM, Martins MD, Silva NP, Preto PM, Preto LS. Resultados da implementação do protocolo da via verde do acidente vascular cerebral num hospital português. Rev Enf Ref. 2019;4:117-26. DOI: https://doi.org/10.12707/RIV18085
Gomes E, Moreira D, Chaló D, Dias C, Neutel E, Aragão I, et. al. O doente politraumatizado grave: implicações da ruralidade na mortalidade, incapacidade e qualidade de vida. Acta Med Port. 2011;24:81-90. DOI: https://doi.org/10.20344/amp.340
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