1755 The differential determinants of delivering prehospital emergency anaesthesia within 45-minutes of the 999-call – a multi-centre, retrospective observational study. Issue 12 (22nd November 2022)

• Record Type: Journal Article
• Authors: Kratz, Maria; Price, James; Lachowycz, Kate; Major, Rob; Moncur, Lyle; McLachlan, Sarah; Keeliher, Chris; Steele, Alistair; Barnard, Ed
• Is Part Of: Emergency medicine journal. Volume 39:Issue 12(2022)
• Page Start: A975
• Page End: A975
• Publication Date: 2022-11-22
• Subjects: Emergency medicine -- Periodicals; 616.02505
• DOI: 10.1136/emermed-2022-RCEM2.24
• Languages: English
• ISSNs: 1472-0205

Abstract

Abstract : Aims, Objectives and Background: Prehospital emergency anaesthesia (PHEA) is a necessary intervention for a significant proportion of severely injured trauma patients. The National Institute for Health and Care Excellence (NICE) trauma quality standards include delivery of prehospital emergency anaesthesia (PHEA), where indicated, ≤45-minutes of the 999-call. The aim of this study was to report the differential determinants of meeting this standard in a large regional cohort of trauma patients. Method and Design: A consecutive sample of adult trauma patients undergoing PHEA (2015–2020) at three Helicopter Emergency Medical Services (HEMS) in the East of England. The primary outcome was PHEA ≤45-minutes of 999-call; defined as duration between call 'pick-up' and administration of anaesthetic drugs. Data were extracted from all three HEMS electronic medical records (HEMSbase, MedicOne Systems), and combined. Variables included: dispatch type (immediate, interrogate, crew-request), demographics, time of day (day/night), PHEA indication, pre-PHEA physiology. A purposeful selection logistic regression model was used in R (a language and environment for statistical computing). Each variable was first tested in turn to explore the unadjusted association with the outcome. Significant variables were then included in the multivariable analysis. Variables were successively eliminated until only statistically significant variables remained. This was a service evaluation study (EAAA 2021/025). Results and Conclusion: 1, 155 adult trauma patients were included in the analysis. The primary outcome, PHEA ≤45-minute of 999-call, was achieved in n=196 (17.0%) of cases. The data model is under construction. However, there is signal that non-immediate dispatch type, older age, and night-time operations are all associated with a reduced likelihood of delivering PHEA ≤45-minutes of the 999-call. Less than one in five trauma patients receive PHEA ≤45-minutes of the 999-call in the East of England. Results from this project may positively influence dispatch systems in order to increase the timely delivery of prehospital anaesthesia where indicated (pending the complete data model).