The Critical Response Time Threshold to Increase 24-hour Mortality in Emergency Medical Service Operations: A Study at Saraburi Hospital
Keywords:
Response Time, Emergency Medical Service, Hazard ratio, 24-hour deathAbstract
Background: Response time (RT) refers to the duration in minutes from the moment an incident is reported to the emergency dispatch center until the operational team arrives at the scene. Objective: This study aimed to investigate the relationship and determine the optimal response time (RT) that most significantly impacts 24-hour mortality among patients with critical and severe emergency conditions, focusing on emergency medical service operations within the jurisdictional area of Saraburi Hospital, Thailand. Methods: This explanatory retrospective cohort study focused on emergency patients who reported incidents via the 1669 hotline or other channels and were dispatched to advanced life support (ALS) teams using the red code protocol from May 2017 to July 2019, with 2,500 cases. Data was analyzed and presented with flexible parametric survival analysis to find RT values that affect the hazard ratio each minute that passes for patients who die within 24 hours. Results: After excluding 179 cases that did not meet the inclusion criteria, the remaining 2,321 cases were analyzed. Among these, 118 cases resulted in death within 24 hours. The crude HR of RT was 0.97 (95%CI: 0.94, 1.00, p = .06), while the adjusted HR was 1.05 (95%CI: 0.97, 1.14, p= .20). Upon examining RT on a minute-by-minute basis, the adjusted HR was found to be significantly higher within the first 2 minutes (adjHR) 3.85, 95%CI: 1.00, 14.79, p = .05) and between 12-16 minutes (adjHR) 0.40, 95%CI: 0.18, 0.88, p = .02) - (adjHR) 2.62, 95%CI: 1.14, 6.03, p = .02)]. The time interval associated with the lowest hazard risk corresponded to an RT of 7-12 minutes, although this finding was not statistically significant. Conclusions: Prolonged RT values were associated with an increased risk of 24-hour mortality, and RTs exceeding 12-16 minutes were significantly correlated with a higher likelihood of death.
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