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Tempos de resposta e intervenções extra-hospitalar à vítima de trauma major na Região Centro de Portugal: Um estudo retrospetivo
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Advisor(s)
Abstract(s)
Introdução: A qualidade e rapidez do socorro pré-hospitalar à pessoa vítima de trauma major é vital para diminuir a sua elevada mortalidade. Contudo,
desconhece-se a efetividade desta resposta em Portugal. O objetivo deste estudo foi analisar os tempos de resposta e as intervenções realizadas às
vítimas de trauma major na região centro de Portugal.
Métodos: Estudo retrospetivo, descritivo, utilizando os registos clínicos de 2022 dos meios diferenciados do Instituto Nacional de Emergência Médica.
Casos de óbito pré-chegada ao hospital e outras situações de não transporte foram excluídos. Determinaram-se cinco tempos, entre os quais o tempo
de resposta (T1, decorrente entre acionamento e chegada ao local), o tempo no local (T2) e o tempo de transporte (T5, intervalo entre a decisão de
transporte e a chegada ao serviço de urgência). Foram calculadas médias e medidas de dispersão para cada meio, bem como a proporção de casos em
que foram cumpridos os tempos recomendados nacional e internacionalmente. Avaliou-se também a frequência de registo de seis intervenções chave.
Resultados: Dos 3366 registos, eliminaram-se 602 (384 por óbito), resultando em 2764 casos [suporte imediato de vida (SIV) = 36,0%, viaturas médicas
de emergência e reanimação (VMER) = 62,2%, helicóptero de emergência médica (HEM) = 1,8%]. Num elevado número de registos não foi possível
determinar tempos de socorro: por exemplo, o tempo de transporte (T5) foi determinável em apenas 29%, 13%, e 8% dos casos, respetivamente para
SIV, VMER e HEM. O tempo recomendado para a estabilização (T2 ≤ 20 min), foi cumprido em 19,8% (SIV), 36,5% (VMER), e 18,2% (HEM) dos registos.
Já o tempo de transporte (T5 ≤ 45 min) foi cumprido em 80,0% (SIV), 93,1% (VMER) e 75,0% (HEM) dos registos (avaliáveis). A administração de
analgesia (42% na SIV) e as medidas de prevenção de hipotermia (23,5% na SIV) foram as intervenções mais registadas.
Conclusão: Observaram-se muitos status omissos e falta de informação nos registos, sobretudo na VMER e HEM. De acordo com os registos, o tempo
no local superou frequentemente as recomendações, enquanto o tempo de transporte tende a estar dentro das normas.
Introduction: The quality and promptness of prehospital care for major trauma patients are vital in order to lower their high mortality rate. However, the effectiveness of this response in Portugal is unknown. The objective of this study was to analyze response times and interventions for major trauma patients in the central region of Portugal Methods: This was a retrospective, descriptive study, using the 2022 clinical records of the National Institute of Medical Emergency’s differentiated resources. Cases of death prior to arrival at the hospital and other non-transport situations were excluded. Five-time intervals were determined, among which are the response time (T1, between activation and arrival at the scene), on-scene time (T2), and transportation time (T5; between the decision to transport and arrival at the emergency service). For each ambulance type, averages and dispersion times were calculated, as well as the proportion of cases in which the nationally and internationally recommended times were met. The frequency of recording six key interventions was also assessed. Results: Of the 3366 records, 602 were eliminated (384 due to death), resulting in 2764 cases: nurse-technician ambulance (SIV) = 36.0%, physiciannurse ambulance (VMER) = 62.2% and physician-nurse helicopter = 1.8%. In a very large number of records, it was not possible to determine prehospital care times: for example, transport time (T5) could be determined in only 29%, 13% and 8% of cases, respectively for SIV, VMER and helicopter. The recommended time for stabilization (T2 ≤ 20 min) was met in 19.8% (SIV), 36.5% (VMER) and 18.2% (helicopter). Time to hospital (T5 ≤ 45 min) was achieved in 80.0% (SIV), 93.1% (VMER) and 75.0% (helicopter) of the records. The administration of analgesia (42% in SIV) and measures to prevent hypothermia (23.5% in SIV) were the most recorded interventions. Conclusion: There was substantial missing data on statuses and a lack of information in the records, especially in the VMER and helicopter. According to the records, the time taken to stabilize the victim on-scene often exceeded the recommendations, while the time taken to transport them to the hospital tended to be within the recommendations.
Introduction: The quality and promptness of prehospital care for major trauma patients are vital in order to lower their high mortality rate. However, the effectiveness of this response in Portugal is unknown. The objective of this study was to analyze response times and interventions for major trauma patients in the central region of Portugal Methods: This was a retrospective, descriptive study, using the 2022 clinical records of the National Institute of Medical Emergency’s differentiated resources. Cases of death prior to arrival at the hospital and other non-transport situations were excluded. Five-time intervals were determined, among which are the response time (T1, between activation and arrival at the scene), on-scene time (T2), and transportation time (T5; between the decision to transport and arrival at the emergency service). For each ambulance type, averages and dispersion times were calculated, as well as the proportion of cases in which the nationally and internationally recommended times were met. The frequency of recording six key interventions was also assessed. Results: Of the 3366 records, 602 were eliminated (384 due to death), resulting in 2764 cases: nurse-technician ambulance (SIV) = 36.0%, physiciannurse ambulance (VMER) = 62.2% and physician-nurse helicopter = 1.8%. In a very large number of records, it was not possible to determine prehospital care times: for example, transport time (T5) could be determined in only 29%, 13% and 8% of cases, respectively for SIV, VMER and helicopter. The recommended time for stabilization (T2 ≤ 20 min) was met in 19.8% (SIV), 36.5% (VMER) and 18.2% (helicopter). Time to hospital (T5 ≤ 45 min) was achieved in 80.0% (SIV), 93.1% (VMER) and 75.0% (helicopter) of the records. The administration of analgesia (42% in SIV) and measures to prevent hypothermia (23.5% in SIV) were the most recorded interventions. Conclusion: There was substantial missing data on statuses and a lack of information in the records, especially in the VMER and helicopter. According to the records, the time taken to stabilize the victim on-scene often exceeded the recommendations, while the time taken to transport them to the hospital tended to be within the recommendations.
Description
Keywords
Cuidados Avançados de Suporte de Vida no Trauma Fatores de Tempo Ferimentos e Lesões Medicina de Emergência Serviços de Emergência Médica Transporte de Doentes
Citation
Rito, S., Ferreira, R. J., Marques, N., Frutuoso, A., & Baptista, R. (2024). Tempos de resposta e intervenções extra-hospitalar à vítima de trauma major na Região Centro de Portugal: Um estudo retrospetivo. Acta Médica Portuguesa, 37(7-8), 526–534. https://doi.org/10.20344/amp.20983. Acta Médica Portuguesa, 37(7-8), 526–534. https://doi.org/10.20344/amp.20983
Publisher
Ordem dos Médicos