Effects of ground EMS and ED personnel on air medical trauma on-site times.

Background: On-site times for helicopter EMS (HEMS) providers are hypothesized to increase when procedures indicated by national standards of care and local HEMS are not consistently completed by ground EMS (GEMS) or ED providers before HEMS arrival in trauma cases.

Methods: In this prospective study, we divided all trauma missions (120) flown by a university-based HEMS during a 3-month period into interfacility missions (between hospitals, ground providers are ED personnel) and scene missions (between scenes and hospitals, ground providers are GEMS). HEMS completed forms identifying which procedures were completed and omitted by GEMS or ED providers. We collected relevant times from county dispatchers and HEMS flight control.

Results: Ground providers frequently did not complete indicated basic and advanced procedures. A relationship existed between scene GEMS omissions and HEMS on-site times. If no procedures were omitted, average HEMS time on-site was 13 minutes, increasing to 17 minutes for one procedure omitted and 20 minutes for two or more. No relationship was found on interfacility missions between ED provider omissions and HEMS on-site times. However, any existing effect may have been eclipsed by external factors significantly extending HEMS on-site times (mean 43 minutes). An average of 93 minutes elapsed between the request for HEMS transport and patient arrival at the transferring hospital.

Conclusions: GEMS frequently omit indicated procedures. For scene missions, reducing the number of indicated procedures omitted by scene GEMS providers could reduce on-site HEMS times. For interfacility missions, further study is indicated to determine what occurs before HEMS is contacted and while HEMS is on-site.