ABSTRACTS
Safety and Timeliness of Emergency Medical Service Administration of Antibiotics for Traumatic InjuriesAuthor: Aaron Peth, BSEMS, NRP | | Associate Authors: Dominic J. Gregorio,, J, MMS, Scott A. Studebaker, NRP, Alexander D. Muniz, OMS-II, Cole G. Camacho, EMT-P, FP-C, Bilie Williams, Douglas F. Kupas, MD, Lawrence H. Brown, PhD
Introduction Early administration of antibiotics for open fractures reduces serious bone and soft tissue infections. The effectiveness of antibiotics in reducing these infections is time dependent, and the American College of Surgeons recommends antibiotics be given within 1 hour of patient arrival to the emergency department (ED). The extent to which prehospital antibiotic administration in these situations might reduce the time to treatment has not been previously reported. Objectives: To describe current prehospital use of antibiotics for traumatic injury, and to estimate the potential time savings associated with antibiotic administration by EMS clinicians. Methods A retrospective analysis was conducted based on the 2022 ESO Data Collaborative research dataset. Subjects were patients who had suffered an injury that resulted in a 9-1-1 scene response and who had received antibiotics from EMS. Time to antibiotic administration was calculated as the elapsed time from EMS dispatch until antibiotic administration and the elapsed time from EMS arrival on scene until antibiotic administration. The minimum potential time saved by EMS antibiotic administration was calculated as the elapsed time from administration until ED arrival. To assess safety, epinephrine administration was used as a proxy for the adverse event of anaphylaxis. Results A total of 1,155 injured patients met the inclusion criteria and received EMS-administered antibiotics. The median and interquartile range (IQR) of elapsed time from EMS dispatch until antibiotic administration was 31 (24–32) minutes; the elapsed time from arrival on scene until antibiotic administration was 21 (16–30) minutes. The median potential time savings associated with prehospital antibiotic administration was 16 (9–27) minutes. Notably, 348 patients (30%) had total prehospital times exceeding 1 hour. None of the patients who received antibiotics also received epinephrine for presumed anaphylaxis. Conclusion EMS clinicians can quickly and safely administer antibiotics to patients with traumatic injuries, potentially reducing the time from injury until antibiotic administration and increasing compliance with current recommendations for antibiotics for patients with open fractures. Limitations of this analysis include the necessity to use injured patients who received antibiotics as a proxy for open fractures and administration of epinephrine as a proxy for anaphylaxis.
|
