Assessing the Impact of Transport Modality on Prehospital Times for Victims of Motorcycle Road Traffic Collisions in the Scottish Highlands.

OBJECTIVE: Dispersed population, mountainous topography, and extreme weather present logistical challenges for the emergency services providing care to the resident population and tourists visiting the Scottish Highlands. Debate over the value of air ambulances has left uncertainty over when they benefit patients and when their use may inadvertently prolong transfer times in rural settings. The primary objective of this study was to find a provisional threshold at which air ambulances are likely to improve time from injury to arrival at the emergency department for this rural patient cohort using motorcycle road traffic collisions as a single trauma etiology.

METHODS: A retrospective search of Scottish Trauma Audit Group data was undertaken within the time frame of January 1, 2019, to September 30, 2020, inclusive to identify adult motorcyclists who had sustained traumatic injuries on highland roads resulting in a transfer to the single trauma unit located within the territorial health board of NHS Highland. For inclusion to the Scottish Trauma Audit Group audit, injuries sustained had resulted in a hospital stay of 3 or more days or death with an Injury Severity Score calculated post-computed tomography/operating room diagnosis. The method of arrival to the hospital was categorized as 1 of the following: road ambulance only, road ambulance (+ prehospital doctor), any involvement of air resources, or self-presentation to hospital.

RESULTS: Forty-two cases were identified. The mean on-scene times were longer for patients who were transported by air by 43 minutes. Within an isochrone of 77 minutes (road transfer time) around Raigmore Hospital in Inverness, transfer by land ambulance was faster than air. The majority of patients received definitive care at Raigmore Hospital and did not require further onward transfer.

CONCLUSION: For adult motorcyclists with traumatic injuries in the Highlands, helicopter transfer appears to reduce transport times when the estimated journey to the trauma unit by land is greater than 77 minutes or approximately 49 miles. Patients injured closer to the hospital should be transferred by land to achieve an earlier arrival time. On-scene times were shorter for patients conveyed by land rather than helicopter, and the presence of a physician during the prehospital phase did not prolong on-scene time.