How long do the Danish emergency medical services stay on the scene to play?

Introduction

Though heavily debated it is still unclear, whether the best approach to prehospital trauma care is to scoop and run or to stay and play. In the bulk of the European countries the guidelines follow the stay and play approach. This implies staying on the scene until at least a secure airway is obtained, intravenous fluid resuscitation is commenced and the spinal column is stabilized. In North Denmark Region all severely traumatized patients are categorized as Code Red Trauma-patients (CRT-patients). In this study we examined the on-scene-times (OSTs) for CRT-patients and compared them with non-CRT-patients.

 

Method

Retrospectively we extracted data for all acutely ill or injured patients treated by the emergency medical services between 1st May and 31st December 2006. The patients were divided in two groups: CRT-patients and non-CRT-patients. We calculated the median OST for the two groups. Secondarily we found the median age and the sexual distribution in the groups. The differences between the groups were tested for statistical significance using the Mann-Whitney-test and the χ²-test.

 

Results

In the study period the emergency ambulances responded to 2,766 high priority patients. Of those 58 patients were categorized as CRT-patients. The OST for the CRT-group was 20.9 min. (interquartile range: 16.8-25.9), while the OST for the non-CRT-group was 15.8 min. (11.3-21.3) (P < 0.001). The CRT-patients had a median age of 39 years (18-51) while the non-CRT-patients’ was 60 years (42-73) (P < 0.001). The fraction of males in the CRT- and non-CRT-groups was 71% and 58% resp. (P = 0.071).

 

Discussion

Our results confirm that the EMS spends more time on major trauma scenes than they do at minor trauma scenes and scenes of medical illness. Compared to the result from an extensive American meta-analysis showing a mean OST on 13.5 min. for trauma patients, the difference between the American scoop and run-approach and the stay and play-approach found in our study becomes evident. The most favourable approach is probably dependent on the transport time from scene to the definitive care that varies between countries.