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Factors Influencing Operational Delays in Prehospital Trauma Interventions: Evidence from a Romanian Cohort.

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Τίτλος: Factors Influencing Operational Delays in Prehospital Trauma Interventions: Evidence from a Romanian Cohort.
Συγγραφείς: Haută A; Gigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania.; Emergency Department, 'Sf. Spiridon' County Clinical Emergency Hospital, 700111 Iasi, Romania., Iacobescu RA; Gigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania., Nedelea PL; Gigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania.; Emergency Department, 'Sf. Spiridon' County Clinical Emergency Hospital, 700111 Iasi, Romania., Corlade-Andrei M; Gigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania.; Emergency Department, 'Sf. Spiridon' County Clinical Emergency Hospital, 700111 Iasi, Romania., Blaga T; Gigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania., Ivanuta M; Gigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania., Ivanuta A; Gigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania.; Emergency Department, 'Sf. Spiridon' County Clinical Emergency Hospital, 700111 Iasi, Romania., Cimpoeșu CD; Gigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania.; Emergency Department, 'Sf. Spiridon' County Clinical Emergency Hospital, 700111 Iasi, Romania.
Πηγή: Medicina (Kaunas, Lithuania) [Medicina (Kaunas)] 2026 Aug 25; Vol. 62 (9). Date of Electronic Publication: 2026 Aug 25.
Τύπος έκδοσης: Journal Article
Γλώσσα: English
Στοιχεία περιοδικού: Publisher: MDPI Country of Publication: Switzerland NLM ID: 9425208 Publication Model: Electronic Cited Medium: Internet ISSN: 1648-9144 (Electronic) Linking ISSN: 1010660X NLM ISO Abbreviation: Medicina (Kaunas) Subsets: MEDLINE
Imprint Name(s): Publication: 2018- : Basel, Switzerland : MDPI
Original Publication: Kaunas : Lietuvos gydytojų sąjunga
Ιατρικοί όροι (MeSH): Emergency Medical Services*/statistics & numerical data , Emergency Medical Services*/methods , Emergency Medical Services*/standards , Wounds and Injuries*/therapy , Wounds and Injuries*/epidemiology , Time-to-Treatment*/statistics & numerical data, Registries/statistics & numerical data ; Humans ; Romania ; Retrospective Studies ; Time Factors ; Female ; Male ; Middle Aged ; Adult ; Treatment Delay ; Cohort Studies ; Aged ; Logistic Models
Περίληψη: Background and Objectives: Trauma is a frequent cause of emergency healthcare requests that requires timely intervention and transport to definitive care, ideally within the first 60 min. On-scene time is considered a modifiable component of the prehospital phase and holds the greatest potential for optimizing prehospital operational time. However, factors contributing to on-scene delays are emerging across different trauma systems, highlighting the need to optimize operational efforts. Data on these factors vary across settings and have rarely been explored in Europe. Romania is an Eastern European country with a distinct demographic distribution and a unique emergency healthcare system. This study aims to evaluate compliance with the golden hour of prehospital trauma care and factors associated with on-scene and total prehospital operational time in Iasi County, Romania. Materials and Methods: A retrospective analysis of data from the electronic dispatch registry from Iasi County was performed for cases dating from January 2025 to February 2026. Data regarding demographics, trauma characteristics, and operational data were retrieved. Generalized linear modeling was used to investigate associations of total prehospital time or on-scene time with demographic and case-specific factors. Multivariable logistic regression was used to evaluate factors associated with total prehospital time exceeding 60 min and on-scene time of 20 min or more. Further sensitivity analyses were performed to account for scene complexity. Age association with operational time was assessed for non-linearity using restricted cubic splines. Results: Of the 8553 included trauma cases, 33.1% presented with on-scene delays, and 59.5% presented with total prehospital time above 60 min. Factors associated with on-scene time were age, rural environment, nature of trauma and severity, and scene-related complexity factors such as number of performed interventions and multiple victim incidents, while for total prehospital time the moment of intervention was also a relevant factor. Age displayed a non-linear association with on-scene time (p < 0.001), with a more pronounced increase after approximately 60 years of age, while for total prehospital time no evidence of non-linearity was observed (time ratio: 1.0024, 95% CI:1.0019-1.0029, p < 0.001). Rural environment was also a factor associated with both operational measurements (time ratio:1.17, 95%CI:1.15-1.2, p < 0.001 for on-scene time and time ratio:1.42, 95% CI:1.38-1.45, p < 0.001 for total prehospital time) and was associated with higher odds of on-scene time ≥ 20 min (OR:1.74, 95% CI:1.58-1.92, p < 0.001) and total prehospital time >60 min (OR:4.91, 95% CI:4.45-5.43, p < 0.001). Conclusions: The large proportion of cases identified with delayed operational times supports the need for further exploration of modifiable factors. The study highlights that, beyond case-specific factors and scene complexity, age and rural environment are relevant to prehospital operational time in Romanian trauma care settings. Further studies are needed to determine the underlying mechanisms of these associations and find targeted strategies to improve operational efficiency.
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Injury. 2015 Apr;46(4):602-9. (PMID: 25627482)
Scand J Trauma Resusc Emerg Med. 2023 Oct 5;31(1):53. (PMID: 37798724)
Scand J Trauma Resusc Emerg Med. 2025 Dec 4;33(1):193. (PMID: 41339901)
Eur J Trauma Emerg Surg. 2026 Jan 13;52(1):9. (PMID: 41528368)
Injury. 2015 Apr;46(4):525-7. (PMID: 25262329)
Scand J Trauma Resusc Emerg Med. 2021 Jul 23;29(1):100. (PMID: 34301281)
BMC Emerg Med. 2024 Jun 26;24(1):107. (PMID: 38926855)
Int Emerg Nurs. 2020 Jul;51:100880. (PMID: 32622226)
World J Emerg Surg. 2024 May 31;19(1):18. (PMID: 38816766)
Am J Surg. 2022 Jun;223(6):1200-1205. (PMID: 34756693)
J Trauma Acute Care Surg. 2022 Mar 1;92(3):520-527. (PMID: 34407005)
PLoS One. 2021 Jun 2;16(6):e0252044. (PMID: 34077438)
Scand J Trauma Resusc Emerg Med. 2025 Jul 10;33(1):123. (PMID: 40640930)
Inj Prev. 2016 Feb;22(1):3-18. (PMID: 26635210)
Eur J Trauma Emerg Surg. 2023 Oct;49(5):2165-2172. (PMID: 37162554)
BMC Emerg Med. 2024 Jan 7;24(1):10. (PMID: 38185622)
Health Serv Res. 2020 Jun;55(3):411-418. (PMID: 31994218)
Cureus. 2026 Jul 12;18(7):e112545. (PMID: 42591314)
BMC Emerg Med. 2025 Aug 20;25(1):163. (PMID: 40830842)
Ann Fr Anesth Reanim. 2012 Jan;31(1):e7-e10. (PMID: 22206731)
JAMA Surg. 2017 Jan 1;152(1):11-18. (PMID: 27732713)
J Trauma Acute Care Surg. 2016 Jul;81(1):93-100. (PMID: 26886000)
Eur J Emerg Med. 2018 Dec;25(6):446-447. (PMID: 30379716)
West J Emerg Med. 2020 Feb 21;21(2):455-462. (PMID: 32191204)
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Trauma Surg Acute Care Open. 2024 Jul 16;9(1):e001395. (PMID: 39021732)
Grant Information: Ph.D. grant nr. 2245/2022 Grigore T. Popa University of Medicine and Pharmacy
Contributed Indexing: Keywords: emergency medical services; on-scene time; operational delays; prehospital trauma care; time factors
Entry Date(s): Date Created: 20260926 Date Completed: 20260926 Latest Revision: 20260929
Update Code: 20260929
PubMed Central ID: PMC13608640
DOI: 10.3390/medicina62091632
PMID: 42796239
Βάση Δεδομένων: MEDLINE
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  Data: Factors Influencing Operational Delays in Prehospital Trauma Interventions: Evidence from a Romanian Cohort.
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  Data: Background and Objectives: Trauma is a frequent cause of emergency healthcare requests that requires timely intervention and transport to definitive care, ideally within the first 60 min. On-scene time is considered a modifiable component of the prehospital phase and holds the greatest potential for optimizing prehospital operational time. However, factors contributing to on-scene delays are emerging across different trauma systems, highlighting the need to optimize operational efforts. Data on these factors vary across settings and have rarely been explored in Europe. Romania is an Eastern European country with a distinct demographic distribution and a unique emergency healthcare system. This study aims to evaluate compliance with the golden hour of prehospital trauma care and factors associated with on-scene and total prehospital operational time in Iasi County, Romania. Materials and Methods: A retrospective analysis of data from the electronic dispatch registry from Iasi County was performed for cases dating from January 2025 to February 2026. Data regarding demographics, trauma characteristics, and operational data were retrieved. Generalized linear modeling was used to investigate associations of total prehospital time or on-scene time with demographic and case-specific factors. Multivariable logistic regression was used to evaluate factors associated with total prehospital time exceeding 60 min and on-scene time of 20 min or more. Further sensitivity analyses were performed to account for scene complexity. Age association with operational time was assessed for non-linearity using restricted cubic splines. Results: Of the 8553 included trauma cases, 33.1% presented with on-scene delays, and 59.5% presented with total prehospital time above 60 min. Factors associated with on-scene time were age, rural environment, nature of trauma and severity, and scene-related complexity factors such as number of performed interventions and multiple victim incidents, while for total prehospital time the moment of intervention was also a relevant factor. Age displayed a non-linear association with on-scene time (p &amp;lt; 0.001), with a more pronounced increase after approximately 60 years of age, while for total prehospital time no evidence of non-linearity was observed (time ratio: 1.0024, 95% CI:1.0019-1.0029, p &amp;lt; 0.001). Rural environment was also a factor associated with both operational measurements (time ratio:1.17, 95%CI:1.15-1.2, p &amp;lt; 0.001 for on-scene time and time ratio:1.42, 95% CI:1.38-1.45, p &amp;lt; 0.001 for total prehospital time) and was associated with higher odds of on-scene time ≥ 20 min (OR:1.74, 95% CI:1.58-1.92, p &amp;lt; 0.001) and total prehospital time &gt;60 min (OR:4.91, 95% CI:4.45-5.43, p &amp;lt; 0.001). Conclusions: The large proportion of cases identified with delayed operational times supports the need for further exploration of modifiable factors. The study highlights that, beyond case-specific factors and scene complexity, age and rural environment are relevant to prehospital operational time in Romanian trauma care settings. Further studies are needed to determine the underlying mechanisms of these associations and find targeted strategies to improve operational efficiency.
– Name: Ref
  Label: References
  Group: RefInfo
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– Name: GrantInfo
  Label: Grant Information
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  Data: Ph.D. grant nr. 2245/2022 Grigore T. Popa University of Medicine and Pharmacy
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  Data: &lt;i&gt;Keywords: &lt;/i&gt;emergency medical services; on-scene time; operational delays; prehospital trauma care; time factors
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  Data: 10.3390/medicina62091632
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        Value: 10.3390/medicina62091632
    Languages:
      – Code: eng
        Text: English
    Subjects:
      – SubjectFull: Registries statistics & numerical data
        Type: general
      – SubjectFull: Humans
        Type: general
      – SubjectFull: Romania
        Type: general
      – SubjectFull: Retrospective Studies
        Type: general
      – SubjectFull: Time Factors
        Type: general
      – SubjectFull: Female
        Type: general
      – SubjectFull: Male
        Type: general
      – SubjectFull: Middle Aged
        Type: general
      – SubjectFull: Adult
        Type: general
      – SubjectFull: Treatment Delay
        Type: general
      – SubjectFull: Cohort Studies
        Type: general
      – SubjectFull: Aged
        Type: general
      – SubjectFull: Logistic Models
        Type: general
      – SubjectFull: Emergency Medical Services statistics & numerical data
        Type: general
      – SubjectFull: Emergency Medical Services methods
        Type: general
      – SubjectFull: Emergency Medical Services standards
        Type: general
      – SubjectFull: Wounds and Injuries therapy
        Type: general
      – SubjectFull: Wounds and Injuries epidemiology
        Type: general
      – SubjectFull: Time-to-Treatment statistics & numerical data
        Type: general
    Titles:
      – TitleFull: Factors Influencing Operational Delays in Prehospital Trauma Interventions: Evidence from a Romanian Cohort.
        Type: main
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            NameFull: Haută A
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            NameFull: Iacobescu RA
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          Dates:
            – D: 25
              M: 08
              Text: 2026 Aug 25
              Type: published
              Y: 2026
          Identifiers:
            – Type: issn-electronic
              Value: 1648-9144
          Numbering:
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              Value: 62
            – Type: issue
              Value: 9
          Titles:
            – TitleFull: Medicina (Kaunas, Lithuania)
              Type: main
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