The impact of advanced pre-hospital interventions on scene time.

Abstract

Background: Pre-hospital trauma care has evolved with the introduction of increasingly advanced interventions. While these procedures may offer clinical benefit, they may also prolong pre-hospital times, a critical determinant of outcome, particularly in patients with non-compressible haemorrhage. This study examined whether expanding pre-hospital capability has affected scene time over the past two decades.

Methods: We conducted a retrospective, observational study of injured patients treated by a physician-led air ambulance service. Data from July of each year between 2005-2010 (Group 1) and 2017-2021 (Group 2) were compared. Advanced interventions including blood transfusion, Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA), arterial and central venous cannulation were introduced between these periods. Univariate and multivariable analyses were performed to identify factors associated with scene time.

Results: Among 1,357 eligible patients, 26% received at least one advanced intervention, with uptake increasing over time (24% vs 29%; p = 0.02). The proportion of penetrating trauma also increased (24% vs 34%; p < 0.001), and these patients had consistently shorter scene times than those with blunt trauma (10 [6-17] vs 25 [17-36] minutes; p < 0.001). Median scene time remained similar between study periods. In multivariable analysis, scene time was independently associated with mechanism of injury, age, and number of advanced interventions performed. Each additional intervention increased scene time by 41% (p < 0.001).

Conclusion: Advanced pre-hospital interventions have become more frequent, and scene time increases in direct proportion to the number of interventions performed, independent of temporal, operational, patient, and injury factors. Scene times have remained similar over two decades, reflecting opposing trends of increasing intervention frequency and more penetrating trauma. These findings highlight the need to balance the potential benefit of advanced pre-hospital interventions against their time cost, ensuring procedural efficiency, judicious patient selection, and timely transfer to definitive care in time-critical trauma.