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. 2023 Aug 22;31(1):39.
doi: 10.1186/s13049-023-01109-6.

Pre-hospital and retrieval medicine in Scotland: a retrospective cohort study of the workload and outcomes of the emergency medical retrieval service in the first decade of national coverage

Ryan D McHenry  1 , Christopher Ej Moultrie  2 , Andrew J Cadamy  2 , Alasdair R Corfield  2 , Daniel F Mackay  3 , Jill P Pell  3
Affiliations

Pre-hospital and retrieval medicine in Scotland: a retrospective cohort study of the workload and outcomes of the emergency medical retrieval service in the first decade of national coverage

Ryan D McHenry et al. Scand J Trauma Resusc Emerg Med. .

Abstract

Background: The Emergency Medical Retrieval Service (EMRS) has provided national pre-hospital critical care and aeromedical retrieval in Scotland since 2010. This study investigates trends in the service and patients attended over the last decade; and factors associated with clinical deterioration and pre-hospital death.

Methods: A retrospective cohort study was conducted of all service taskings over ten years (2011-2020 inclusive). The EMRS electronic database provided data on location, sociodemographic factors, diagnoses, physiological measurements, clinical management, and pre-hospital deaths. Binary logistic regression models were used to determine change in physiology in pre-hospital care, and factors associated with pre-hospital death. Geospatial modelling, using road and air travel time models, was used to explore transfer times.

Results: EMRS received 8,069 taskings over the study period, of which 2,748 retrieval and 3,633 pre-hospital critical care missions resulted in patient contact. EMRS was more commonly dispatched to socioeconomically deprived areas for pre-hospital critical care incidents (Spearman's rank correlation, r(8)=-0.75, p = 0.01). In multivariate analysis, systolic blood pressure < 90mmHg, respiratory rate < 6/min or > 30/min, and Glasgow Coma Score ≤ 14 were associated with pre-hospital mortality independent of demographic factors. Geospatial modelling suggested that aeromedical retrieval reduced the mean time to a critical care unit by 1 h 46 min compared with road/ferry transportation.

Conclusion: EMRS continues to develop, delivering Pre-Hospital and Retrieval Medicine across Scotland and may have a role in addressing health inequalities, including socioeconomic deprivation and geographic isolation. Age, specific distances from care, and abnormal physiology are associated with death in pre-hospital critical care.

Keywords: Geospatial modelling; Mortality; Outcomes; Pre-Hospital Emergency Medicine; Retrieval Medicine.

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Conflict of interest statement

RM is a Clinical Research Fellow at ScotSTAR. CM, AJC and ARC are Consultants in Pre-Hospital and Retrieval Medicine at EMRS. The remaining authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Map of referral locations for retrieval taskings to Emergency Medical Retrieval Service. Width of line from origin to referring centre is proportional to the number of retrievals undertaken to each destination
Fig. 2
Fig. 2
Isochrone maps of time to critical care unit in Scotland in two transport models. The first, modelled time by road alone to each critical care unit (Fig. 2a) and the second, modelled time using the faster of either road or the current configuration of aeromedical services to each critical care unit (Fig. 2b)
Fig. 3
Fig. 3
Map of Scotland, with shaded area indicating areas where EMRS provides fastest modelled access to initiation of critical care, with locations of remote community hospitals and isolated general practitioner or nursing provision
Fig. 4
Fig. 4
Bar chart of pre-hospital critical care mission frequency by Scottish Index of Multiple Deprivation decile
See this image and copyright information in PMC

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