Prehospital times and outcomes of patients transported using an ambulance trauma transport protocol: A data linkage analysis from New South Wales Australia

Michael Dinh; Hardeep Singh; Colin Deans; Grant Pople; Jason Bendall; Pooria Sarrami

doi:10.1016/j.injury.2023.110988

Prehospital times and outcomes of patients transported using an ambulance trauma transport protocol: A data linkage analysis from New South Wales Australia

Injury. 2023 Oct;54(10):110988. doi: 10.1016/j.injury.2023.110988. Epub 2023 Aug 7.

Authors

Michael Dinh¹, Hardeep Singh², Colin Deans³, Grant Pople³, Jason Bendall³, Pooria Sarrami⁴

Affiliations

¹ NSW Institute for Trauma and Injury Management (ITIM), NSW Agency for Clinical Innovation (ACI), Australia; Sydney Medical School, the University of Sydney, Australia.
² NSW Institute for Trauma and Injury Management (ITIM), NSW Agency for Clinical Innovation (ACI), Australia.
³ NSW Ambulance, Australia.
⁴ NSW Institute for Trauma and Injury Management (ITIM), NSW Agency for Clinical Innovation (ACI), Australia; South Western Sydney Clinical School, University of New South Wales, Australia. Electronic address: Pooria.sarrami@health.nsw.gov.au.

PMID: 37574381
DOI: 10.1016/j.injury.2023.110988

Abstract

Introduction: Prehospital trauma systems are designed to ensure optimal survival from critical injuries by triaging and transporting such patients to the most appropriate hospital in a timely manner.

Objectives: We sought to evaluate whether prehospital time and location (metropolitan versus non-metropolitan) were associated with 30-day mortality in a cohort of patients transported by road ambulance using a trauma transport protocol.

Methods: Data linkage analysis of routinely collected ambulance and hospital data across all public hospitals in New South Wales (NSW). The data linkage cohort included adult patients (age ≥ 16years) transported by NSW Ambulance, where a T1 Major Trauma Transport Protocol was documented by paramedic crews and transported by road to a public hospital emergency department in NSW for two years between January 2019 and December 2020. The outcomes of interest were prehospital times (response time, scene time and transport time) and 30-day mortality due to injury.

Results: 9012 cases were identified who were transported to an emergency department with T1 protocol indication. Median prehospital transport times were longer in non-metropolitan road transports [n = 3,071, 98 min (71-126)] compared to metropolitan transports [n = 5,941, 65 min (53-80), p < 0.001]. There was no significant difference in 30-day mortality between the two groups (1.24% vs 1.65%, p = 0.13). In the subgroup of patients with abnormal vital signs, the only predictors of mortality were increasing age, presence of severe injury (OR 24.87, 95%CI 11.02, 56.15, p < 0.001), and arrival at a non-trauma facility (OR 3.01, 95%CI 1.26, 7.20, p < 0.05). Increasing transport times were not found to increase the odds of 30-day mortality.

Discussion: In the context of an inclusive trauma system and an established prehospital major trauma protocol, increasing prehospital transport times and scene location were not associated with increased mortality.

Keywords: Data linkage; Injury; Prehospital trauma systems; Trauma protocols.

MeSH terms

Adolescent
Adult
Ambulances
Australia
Emergency Medical Services* / methods
Emergency Service, Hospital
Humans
New South Wales / epidemiology
Retrospective Studies
Trauma Centers
Wounds and Injuries* / therapy