Factors contributing to paramedic onscene time during evaluation and management of blunt trauma.

Prehospital patient management decisions are complex because the traumatized patient population is heterogeneous with respect to demographics, mechanism of injury, physiological response to injury, and time from injury to medical care. One hundred and nine blunt trauma patient evaluations by paramedics in a county-wide semirural emergency medical services (EMS) system were analyzed to determine paramedic time on the scene and the factors that might influence onscene time. Onscene time linearly correlated with a prolonged transport time. Hemodynamic and respiratory dysfunction were also associated with increased onscene time. Mean onscene time was not significantly different between high (greater than 13) and low (less than or equal to 13) trauma score (TS) groups, although patients with low TS did receive more interventions (more intravenous lines, more frequent intubation, and more frequent pneumatic antishock garment use). Similar results were found when high (greater than 10) and low (less than or equal to 10) Glasgow Coma Scale (GCS) groups were compared. The correlation of emergency department TS with initial prehospital TS and onscene time demonstrated a small improvement in TS with increasing onscene time for the patient with an initial TS greater than or equal to 13. However, patient groups with either a low TS or a low GCS score showed no significant improvement in TS with increasing onscene time. Without a strict management algorithm, paramedics use a variety of cues to guide their actions during the onscene management of blunt trauma. Future studies should address the impact of strict management algorithms on onscene time and ultimate patient outcome.