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Impact of Violations of the Shortest Distance-Based Transport Protocol for Intra-Arrest on Clinical Outcomes in a

Ju Hwan Choi1, Arom Choi2,3, Hanna Yoon2,3

  • 1Department of Emergency Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Republic of Korea.

Journal of Clinical Medicine
|February 13, 2026
PubMed

Insights

Hospital transport protocol violations for out-of-hospital cardiac arrest patients did not impact survival or neurological outcomes. Transport strategies should prioritize real-time resource availability and evidence-based approaches for better patient care.

Area of Science:

  • Emergency Medicine
  • Cardiology
  • Public Health

Background:

  • Optimal hospital transport strategies for out-of-hospital cardiac arrest (OHCA) patients remain undefined.
  • A shortest-route transport protocol was implemented in South Korea to reduce prehospital time but is frequently breached.
  • The impact of these protocol violations on patient outcomes requires investigation.

Purpose of the Study:

  • To evaluate the association between transport protocol violations and clinical outcomes in OHCA patients.
  • To determine if protocol violations influence emergency department mortality and neurological outcomes.
  • To explore the mediating role of transport time in the relationship between protocol violations and outcomes.

Main Methods:

  • Retrospective observational study of 3474 OHCA patients transported by emergency medical services (September 2021 - December 2022).
  • Analysis of run sheets, cardiac arrest registry, and surveillance data for demographics, times, Utstein factors, and outcomes.
  • Logistic regression and mediation analyses were used to assess associations.

Main Results:

  • Transport protocol violations occurred in 44.2% of cases and were linked to longer scene and transfer times.
  • Emergency department survival rates were similar between protocol violation (15.4%) and non-violation (16.4%) groups.
  • Protocol violations were not significantly associated with mortality (OR 1.04) or poor neurological outcomes (OR 1.00).

Conclusions:

  • Transport protocol violations in OHCA patients did not adversely affect short-term clinical outcomes.
  • Increased transfer time did not mediate the effect of protocol violations on outcomes.
  • Future transport strategies should integrate real-time resource availability and evidence-based decision-making.

Keywords:
cardiac arrestemergency medical servicesresuscitationtransport protocol

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