Effect of standing orders on paramedic scene time for trauma patients

Study objective: To determine if a protocol change that allowed paramedics to perform certain procedures before base station contact (standing orders) would decrease scene time in trauma patients. Design: Retrospective review of case series. Setting: A single-tiered, all advanced life support emergency medical services system. Intervention: Implementation with standing orders for invasive procedures. Type of participants: All physiologically unstable trauma patients transported to a Level I trauma center by ambulance. Measurements and main results: One hundred ninety-seven patients met the inclusion criteria - 87 before and 110 after the initiation of standing orders. Mean scene times for the control group (15.3 ± 8.4 minutes) and for the standing orders group (15.1 ± 7.6 minutes) were similar (P = .18). The power of the study to detect a two-minute difference in scene time was .92. Scene time was not influenced by mechanism of injury, and the number of procedures performed on patients was similar between the two groups. Conclusion: Standing orders did not decrease scene time in physiologically unstable trauma patients. Further study is necessary to delineate the factors that actually contribute to on-scene time and the factors that are important in determining whether standing orders or on-line medical contact should be used.