The catchment area of these services is rural and includes islands, fjords, mountains, rough terrain, and narrow roads, as well as two major cities, Stavanger and Bergen. This is a retrospective cohort study designed to investigate OST in the three HEMS bases in Førde, Bergen, and Stavanger, which cover the western region of Norway. Cardiac arrest patients were also assessed for comparison, with an increased OST anticipated for this group. Our objectives were to assess OST in the HEMS and to investigate whether selected factors affect it in four specific and severe conditions in which a short OST was anticipated. Clarifying these factors may improve decision making and treatment protocols, and provide a basis for targeted training, aiming to reduce OST in specific missions. The main factors affecting OST have been described for trauma patients, but not specifically for all five conditions in the First Hour Quintet. The OST is the prehospital time interval that can be reduced, as transport times are mostly determined by the distance to the hospital. An on-scene HEMS physician does not necessarily increase the OST, though more advanced interventions may be initiated. An important supplement is the physician-staffed emergency medical services, including the helicopter emergency medical service (HEMS). The backbone of Norwegian prehospital emergency medical care is ground ambulances and on-call general practitioners in the municipalities. The value of shortening the prehospital time has not received similar attention in medical emergencies, but reducing the interval between diagnosis and treatment for stroke and myocardial infarction seems beneficial. Prolonged OST seems to increase mortality for trauma patients, however not in all settings and conditions. Many studies have assessed on-scene time (OST), but not all have found an association with mortality.
A European project accentuated the so-called “First Hour Quintet” (cardiac arrest, respiratory failure, trauma, acute coronary syndrome, and stroke) as critical conditions of great importance in prehospital emergency care. Patients suffering from a severe illness or injury require immediate prehospital assessment, appropriate treatment, and, in many cases, rapid transport to the hospital accompanied by competent personnel. The most important factors associated with increased on-scene time were the severity of the patient’s condition, the need for intubation or intravenous analgesic, helicopter transport, and trauma missions. Our results provide a basis for efforts to improve decision making and reduce OST for selected patient groups. The time spent on-scene and its influencing factors were dependent on the patient’s condition. For the various patient subgroups, the strength of association between factors and OST varied.
We found a short OST in preselected conditions compared to other studies. Treatment prior to HEMS arrival reduced the on-scene time in patients suffering from acute myocardial infarction. Endotracheal intubation increased the OST by almost 10 minutes. Based on multivariate linear regression analysis, the severity of the patient’s condition, advanced interventions performed, mode of transport, and trauma missions increased the on-scene time.
The median on-scene time in patients with penetrating torso injuries was 5 minutes (IQR 3–10), whereas in cardiac arrest patients it was 20 minutes (IQR 13–28). The overall median on-scene time was 10 minutes (IQR 5–16). This retrospective cohort study evaluated on-scene time and factors that may affect it for 9757 emergency primary missions by the three HEMSs in western Norway between 20, using graphics and descriptive statistics. Our objectives were to assess on-scene time in the Helicopter Emergency Medical Service (HEMS) in our region and selected factors that may affect it in specific and severe conditions.
Identifying factors that affect on-scene time can improve training, protocols, and decision making. The on-scene time is a part of the prehospital interval that can be decreased, as transport times are determined mostly by the distance to the hospital. Extensive prehospital times may increase mortality in selected patient groups. Critically ill patients need to be immediately identified, properly managed, and rapidly transported to definitive care.