Effect of case identification changes on pre-hospital intubation performance indicators in an Australian helicopter emergency medical service

Objective: A 45-min interval from injury to intubation has been proposed as a performance indicator for severe trauma patient management. In the Sydney pre-hospital system a previous change in case identification systems was associated with activation delay. We aimed to determine if this also decreased the proportion of patients intubated within this benchmark.

Methods: Retrospective cohort study of patients intubated by a helicopter emergency medical service (HEMS) over two time periods. Period 1 dispatch was via HEMS crew directly screening the computerised dispatch system, and period 2 was via paramedics in a central control room. Times from emergency call to intubation were compared.

Results: In the HEMS crew screening period 46/58 (79.31%) intubations met the target, compared with 137/314 (43.6%) in the central control period (P < 0.001). The median (interquartile range) time to intubation in the direct crew screening period was 33 (25-41) min, versus the central control period at 47 (38-60) min (P < 0.001). On multivariate modelling, distance to the scene was related to time to intubation (P < 0.001; Incident Rate Ratio = 1.018, 95% confidence interval 1.015-1.020) as was dispatch system, entrapment/access difficulty and indication for intubation (all P < 0.001).

Conclusions: Time from emergency call to intubation was significantly shorter in the HEMS screening period where all non-trapped cases less than 50 km distant were intubated within the 45-min benchmark. There was no distance where intubation within 45 min could be assured for non-trapped patients in the central control period due to dispatch delays.