Introduction The Emergency Medical Retrieval Service (EMRS) provides a retrieval service to remote and rural communities (>70% of EMRS referrals are from isolated general practices or GP led community hospitals). These facilities are unable to deliver critical care interventions (CCI). CCI are delivered by the EMRS team prior to transfer of the patient to definitive care. The study addresses correlation between total on-scene times (TOST) and the level of intervention delivered.
Methods Prospective data was collected on EMRS secondary retrievals between June 2008—June 2009 from GP led facilities. Primary retrievals, patients from larger rural general hospitals, with on-site anaesthetic cover and patients under the age of 16 were excluded. Data was collected on the interventions undertaken by EMRS during TOST prior to transfer of the patient. Interventions undertaken were scored using TISS-76.
Results EMRS retrieved 133 patients suitable for inclusion. Complete data was available for 97% of patients (n=129), with a mean age of 59 years and an underlying diagnosis of trauma in 30% (n=39) and non-trauma in 70% (n=90). Median APACHE II score for the patients was 9 (interquartile range 9–26). Median TISS score was 14 (interquartile range 10–20). Median TOST was 50 min (interquartile range 35–80 min). Median time for transfer to definitive care was 49 min (interquartile range 33–83 min). Pearsons correlation of TOST (minutes) and TISS EMRS=0.668 (p<0.001).
Limitations Some common modern interventions are not incorporated in TISS-76, for example thrombolysis.
Conclusions/recommendations This study demonstrates a significant relationship between the TOST of the retrieval team and the level of intervention delivered to patients. Further work to define the role played by TOST in relation to patient health outcome could assist in critical care decision making and delivery of pre hospital care.
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