The Association of Total Prehospital Time to Severe Trauma Patient Outcomes in Physician Staffed Emergency Medical Teams in Sarajevo, Bosnia, and Herzegovina

Introduction:The Institute for Emergency Medical Assistance of Canton Sarajevo covers 1,777 square kilometers. All teams are physician staffed and are organized in ten geographic points. Patients are transported to a tertiary care level facility–University Clinical Center Sarajevo. Our objective was to determine the association between total prehospital time and severe trauma patient outcomes in a physician staffed emergency medical system with the hypothesis that the length of prehospital time is insignificant to patient outcome if physician treatment begins on scene.Method:This was a descriptive, retrospective, analytical study conducted from June to December 2020. The data of 153 patients with an ISS score of ≥ 16 was selected from patient registries of both facilities. According to transport duration, patients were assigned to one of four groups: 45 minutes (group 4). Both groups according to the TRISS score were equal in mortality with an expected survival rate margin taken at 70% due to this being the approximate intrahospital survival rate of our patients. The primary outcome was in-hospital mortality, and secondary outcomes included length of hospital stay, length of ICU stay and 30-day survival rate.Results:We found no statistically significant difference to in-hospital mortality in relation to the length of pre-hospital transport when physician treatment begins on scene (p = 0,186). We ruled out any significant difference in length of stay and ICU stay (p = 0,179 and p = 0,173, respectively) among the preselected groups in relation to the length of prehospital time. Also, the 30 day survival rate was unaffected by the length of transport in physician led teams (p = 0,156).Conclusion:With strategically placed physician staffed EMS teams and physician treatment beginning on scene, patient outcome is unaffected by the length of transport.