Delays in care of the critically injured.

Prehospital and resuscitation periods and times to emergency surgery were studied in major trauma victims over two 12-month periods to identify factors causing delay in emergency care. Eighteen patients required emergency surgery in the first group and 13 in the second. The mean presurgery time (i.e. time from arrival in the accident and emergency department to surgery) was 117 min in the first group and 111 min in the second. Causes of delay included a sequential approach to resuscitation and investigation, limited staff and theatre availability, and failure to call the trauma team. Times for resuscitation and times to surgery could be reduced by earlier decision-making, alerting key personnel promptly and performing tasks in parallel.