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

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.