The effect of emergency medical services response on outcome of trauma laparotomy at a Level 1 Trauma Centre in South Africa

Abstract

Background: Due to resource constrained pre-hospital emergency medical services (EMSs) there is a significant delay in injured patients arriving at Groote Schuur Hospital Trauma Centre (GSHTC). The aim of the study was to examine the effectiveness of EMSs in transferring trauma patients to GSHTC. The effect of any delay to laparotomy from injury was noted.

Methods: A prospective audit of patients presented directly from the scene to GSHTC following abdominal trauma over a four-month period was performed. Time from contact to the arrival of EMS at scene – the response time (RT) – was used as an indicator of EMS performance. Postoperative complications were graded according to Clavien-Dindo classification of surgical complications.

Results: A total of 118 patients were admitted to the trauma surgery ward following abdominal trauma. The mechanism was penetrating 101 (85.6%) [stab wounds in 67 (56.8%) and gunshot in 34 (28.8%)], and 17 (14.4%) with blunt injuries. EMSs transported 110 (93.2%) patients. A total of 48 index laparotomies were done during this period, of which 13 patients developed postoperative complications. The median RT of the EMS after contact was 53 min for patients who developed complications. It was significantly longer than for those without complications, 21 min (p < 0.01). The median delay to laparotomies from injury for patients with postoperative complications was 10.3 hours and for those without complications was 7.5 hours. The delay from injury to the theatre was also a significant factor in the development of complications (p = 0.02).

Conclusion: The response delay by EMS and delay from injury to the theatre increased complications. Therefore, rapid response by EMS in transferring trauma patients needs to be strengthened.

Keywords: emergency medical services, response time, laparotomy, postoperative complications, outcome