NCEPOD: Trauma - Who Cares? - London Health Programmes

CHAPTER 4 - Prehospital careFigure 8. Length of time at scene of injury140120Number of patients100806040200≤ 10 > 10 ≤ 20 > 20 ≤ 30 > 30 ≤ 40 > 40 ≤ 50 > 50 ≤ 60 > 60Time (minutes)Time at sceneIn those cases (386/504) where the timings could bedetermined, the vast majority (349), exceeded therecommended length of time on scene of 10 minutes 3 (Figure8). In 71 cases delay was due to entrapment. Even if theentrapped were excluded, 278 cases exceeded 10 minutesat the scene. In a further 105 cases either intubation and/or cannulation were undertaken at the scene, and thesemanoeuvres may have contributed to the extended time atthe scene. The 10 minute on scene recommendation refersto paramedic care and in the presence of a prehospitalphysician system (where more interventions are likely, e.g.tracheal intubation) a longer time is probably justifi able.Transport system and prehospital timingsThe role of helicopters in the management of trauma patientsremains controversial 4 . Some trauma victims may benefi t butothers may not. Previous studies in the USA have suggestedthat total times from alert to arrival at hospital are signifi cantlylonger in all types of location by helicopter as opposed toroad ambulance 5 .There was a greater time to reach hospital from the timeof the emergency call, and an increased time spent at thescene of the incident, for those patients transported byhelicopter (Figure 9).The longer time spent at the scene for patients transportedby helicopter could, in part, be attributed to the greaterlikelihood of there being a doctor on the scene, and of thepatient being intubated before transfer. We were unableto identify which cases were attended by doctors orparamedics.40