Introduction As part of the “lethal triad”, hypothermia (<95°F, <35°C) is associated with increased morbidity and mortality in trauma patients by worsening coagulopathy and acidosis. Emergency Medical Service providers and hospital staff have a responsibility to not only prevent hypothermia, but to actively utilize warming techniques, as these patients remain susceptible to further heat loss. Whether there is an independent association between hypothermia and prehospital transport mode remains unknown. Objective To evaluate the association between prehospital transport mode (helicopter vs. ground ambulance) and hypothermia in adult trauma patients. Methods A retrospective observational cohort study of 740 adult trauma patients (aged 18-89 years) transported to a Level I Trauma Center via helicopter (n=78) or ground ambulance (n=662) from August 1, 2023, through January 31, 2025, was conducted. Patients excluded were those suffering from out-of-hospital cardiac arrest, records missing age or Emergency Department (ED) temperature, non-air/ground EMS transport modes, inter-facility transfers, those who are considered incarcerated and patients who were pregnant. A multiple logistic regression model was used to determine the associations between hypothermia: transport mode, injury severity score (ISS; >15=1), first shock index (SI; >1=1), first Glasgow Coma Scale (GCS; ≤8=1), age, gender, and minority status. Results Hypothermia was identified in 12.82% of patients transported by helicopter compared to 6.19% of patients transported by ground ambulance. The multiple logistic regression model demonstrated that patients transported by helicopter were significantly more likely to have ISS>15 and GCS≤8 but not SI>1 (16.88% versus 10.19%, p=0.077). These results suggest that patients transported by helicopter are more likely to arrive at the ED with hypothermia; however, those patients are also more likely to be critically injured. In the adjusted model, only ISS>15 (OR 3.46, 95% CI 1.71–7.20; p=0.0006) and GCS≤8 (OR 3.76, 95% CI 1.79–7.81; p=0.0004) were independently associated with hypothermia: transport mode and other covariates were not significant. ED temperature was negatively correlated with ISS and positively correlated with GCS. These findings point toward the increased hypothermia prevalence in patients transported by helicopter being attributed to higher injury severity scores, rather than transport mode. Conclusion Although patients arriving by helicopter demonstrate greater rates of hypothermia, this is likely due to their increased probability of exhibiting a higher injury severity score and/or lower GCS rather than the mode of transport.
Objective We aim to explore policies and practices that may be present at Stanford Hospital (SHC) and Stanford Emergency Department that contribute to ambulance patient offload times under thirty minutes. Extended ambulance patient offload times (APOT) are a common issue throughout some areas of the country, resulting in ambulances waiting at emergency departments (ED) to offload their patients for long periods of time. Extended APOTs impact patients, emergency medical services (EMS) and emergency department (ED) health care providers, other branches of emergency services, and hospitals. Methods This qualitative study involved completing in-person and virtual semi-structured interviews with key informants. The interview protocol was developed following a review of the pre-existing literature, an observation session in Stanford’s ED, and from the researcher’s personal experiences in EMS. Participants included English-speaking Stanford Hospital employees with knowledge about policies and practices related to APOTs in Stanford’s ED. The participant population (n=10) consisted of five ED physicians, of which four were male and one female, four female registered nurses, and one female in upper management with a nursing background. Results Our study found five main themes present in Stanford’s ED that could contribute to their ambulance patient offload times being under thirty minutes: (1) alternative care spaces, (2) specialized staff roles, (3) lobby functionality, (4) offload process of EMS patients, and (5) the culture of Stanford’s emergency department. These topics have opened the door for multiple discussion points, which demonstrated participants’ perceptions/opinions/experiences related to ambulance patient offload times in Stanford’s emergency department. Stanford’s ED practices and policies may have contributed to an environment that allows lower APOTs to emerge as a byproduct through the efficient and high-functioning patient care-oriented space. Conclusion These findings demonstrate the importance of taking full advantage of the existing physical space present within and around the emergency department. Patient care spaces can be developed in non-traditional locations, as we saw through Stanford’s lobby and the implementation of a vertical care zone. Beginning non-critical patient assessment and treatment outside of traditional bed areas helps the department reduce delays and optimize use of limited resources without compromising quality of care, especially when looking at ambulance patient offload practices. Although this might not be the most ideal solution, it allows patient care to begin faster and EMS crews to clear the hospital, increasing the amount of ambulances available for emergency responses into our communities. Delays caused by boarding and slow movement of admitted patients to inpatient units point to gaps in how hospitals coordinate and manage patient capacity and movement. The healthcare system is broken, and extended ambulance patient offload times are a symptom, and this should be studied further.
Background and Objectives Unintentional injury remains a leading cause of death in the United States. While rapid transfer to hospitals remains the standard, Mississippi’s rural trauma system faces delays inherent to geography & limited advanced trauma centers. Helicopter emergency medical services (HEMS) may extend definitive trauma care in the pre-hospital setting. AirCare is a HEMS program staffed by critical care paramedics with advanced procedural skills facilitating on-scene advanced resuscitation. We hypothesized that delivery of time-sensitive trauma care by an advanced HEMS program would improve patient outcomes compared with traditional HEMS. Methods We conducted a retrospective cohort study of all adult trauma patients transported directly from the scene to the state’s only level 1 trauma center between January 1, 2018 & December 31, 2019. Exclusions encompassed non-HEMS transport, cases lacking injury severity metrics & prisoners. Patients were categorized by transporting agency: AirCare versus other HEMS. Variables were extracted through manual chart review. Primary outcome was in-hospital mortality; secondary outcomes included hospital length of stay (LOS), ICU LOS & ventilator days. Multivariable logistic regression adjusted for ISS and age was used for the primary outcome; negative binomial and zero-inflated negative binomial models were used for count outcomes. A pre-specified sensitivity analysis was performed in the high-risk subgroup (TRISS < 0.5). Results A total of 329 patients were included; 186 (57%) were transported by AirCare & 143 (43%) by other. The cohort was predominantly male (75%), young (median age 36 years, IQR: 31), and Black (n=157, 48%). AirCare patients had significantly higher injury severity (median ISS 12 vs. 9, p=0.048). In the overall cohort, AirCare was associated with a non-significant trend toward lower in-hospital mortality (aOR 0.52, 95% CI: 0.20–1.33, p=0.2). In the pre-specified high-risk subgroup (TRISS < 0.5, n=59), AirCare was associated with significantly lower mortality (aOR 0.26, 95% CI: 0.07–0.88, p=0.038). AirCare patients also had longer hospital LOS (aIRR: 1.39, 95% CI: 1.11–1.74, p=0.005), & similar ICU LOS (aIRR 0.89, 95% CI: 0.61–1.30, p=0.555) & ventilator days (aIRR 0.77, 95% CI: 0.44–1.35, p=0.362). Conclusion While AirCare transport did not significantly reduce mortality in the overall cohort, a significant survival benefit was observed among the highest-risk patients (TRISS < 0.5); this subgroup was small and should be interpreted cautiously. These findings suggest that advanced pre-hospital resuscitation may be most impactful in patients with the poorest predicted survival, supporting earlier initiation of definitive care in rural trauma systems. Limited sample size & retrospective design constrain generalizability; however, results underscore the potential value of advanced pre-hospital capabilities & justify prospective evaluation.
