Introduction: Mass-casualty incidents (MCIs) have increased globally over the last two decades, both in number and magnitude. Preventable on-scene mortality in MCIs may result from delays in pre-hospital time (PHT). This study aimed to identify factors contributing to PHT delays and explore pre-hospital care providers’ (PHCPs) suggestions to optimize PHT. Methods: A cross-sectional, global online survey was conducted between May and August 2024. PHCPs with experience in at least one MCI were invited via professional associations and social media. Data was collected via a validated questionnaire, including Likert-scale statements to measure agreement levels, multiple-choice, and open-ended questions. Queen Mary Research Ethics Committee (DSREC₀1ᵥ2FAlruqi) approved. Results: There were 225 participants from 54 countries. Of these, 29. 78% were from low- and middle-income countries (LMICs), and 70. 22% were from high-income countries (HICs). Most participants were paramedics (62. 22%), followed by physicians (16. 44%), EMTs (7. 56%), nurses (5. 33%), others (4. 89%), and first responders (3. 56%). The median number of MCIs experienced was 5 (IQR 3 – 14) ; HIC: 5 (IQR 3 – 10) ; LMIC: 10 (IQR 5 – 20). The majority of respondents cited poor communication (84%) and geographical challenges (80%) as primary factors associated with extended PHTs. LMICs reported that equipment inadequacy and hospital distance were also linked to extended times (75% and 63%, respectively). Resource limitations were more of a challenge for LMICs (30. 77% vs 18% in HICs), whereas policy and administrative issues affected 20% of HIC participants compared to none from LMICs. Almost all participants suggested that regular training (95%) and past MCI experience (90%) were key factors for optimizing PHTs. HIC respondents emphasized the benefits of effective communication for shorter PHTs, and improved security was prioritized in LMICs. Conclusion: While geographical location and distance are non-modifiable factors, improving communication in MCI settings may decrease PHTs. Effective communication strategies should be integrated into MCI training and planning.
Alruqi et al. (Sun,) studied this question.