The effect of a quality improvement program on paramedic on-scene times for patients with penetrating trauma

Objective: To decrease paramedic on-scene times (OSTs) for major trauma pat ients through a focused quality improvement (QI) program. Methods: A prospe ctive study was conducted from 1993 through 1997 to determine the impact of a QI program on paramedic OSTs. All penetrating trauma patients transporte d by paramedics to Los Angeles County/USC Medical Center, a Level-1 trauma center, were included, and all cases with OSTs > 20 minutes were reviewed i n detail for extenuating circumstances. Cases including multiple victims or unsecured scenes were considered "acceptable deviations." All others were considered "fallouts," which prompted extensive review with the paramedics and their field supervisors. Results: Prior to the inception of the QI proj ect there was a 4.1% fallout rate of penetrating trauma patients with OSTs > 20 minutes. This fallout rate fell to 1.5% in 1997 (p < 0.01). Mortality rates among these fallouts decreased from 5.1% to 0.8% during the study per iod (p < 0.01). Conclusions: An intensive QI program can have a significant , positive impact on paramedic OSTs among patients with penetrating trauma.