Reduced Mortality in Injured Adults Transported by Helicopter Emergency Medical Services
Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Atlanta, Georgia 30341, USA. Prehospital Emergency Care
(Impact Factor: 1.76).
06/2011; 15(3):295-302. DOI: 10.3109/10903127.2011.569849
Some studies have shown improved outcomes with helicopter emergency medical services (HEMS) transport, while others have not. Safety concerns and cost have prompted reevaluation of the widespread use of HEMS.
To determine whether the mode of transport of trauma patients affects mortality.
Data for 56,744 injured adults aged ≥ 18 years transported to 62 U.S. trauma centers by helicopter or ground ambulance were obtained from the National Sample Program of the 2007 National Trauma Data Bank. In-hospital mortality was calculated for different demographic and injury severity groups. Adjusted odds ratios (AOR) were produced by utilizing a logistic regression model measuring the association of mortality and type of transport, controlling for age, gender, and injury severity (Injury Severity Score [ISS] and Revised Trauma Score [RTS]).
The odds of death were 39% lower in those transported by HEMS compared with those transported by ground ambulance (AOR = 0.61, 95% confidence interval [CI] = 0.54-0.69). Among those aged ≥ 55 years, the odds of death were not significantly different (AOR = 0.92, 95% CI = 0.74-1.13). Among all transports, male patients had a higher odds of death (AOR = 1.23, 95% CI = 1.10-1.38) than female patients. The odds of death increased with each year of age (AOR = 1.040, 95% CI = 1.037-1.043) and each unit of ISS (AOR = 1.080, 95% CI = 1.075-1.084), and decreased with each unit of RTS (AOR = 0.46, 95% CI = 0.45-0.48).
The use of HEMS for the transport of adult trauma patients was associated with reduced mortality for patients aged 18-54 years. In this study, HEMS did not improve mortality in adults aged ≥ 55 years. Identification of additional variables in the selection of those patients who will benefit from HEMS transport is expected to enhance this reduction in mortality.
Available from: Marc Freysz
- "The possibility that shortening pre-hospital times improves survival has not yet been demonstrated in studies with appropriate statistical control . Several large studies have demonstrated that, despite a longer transport time associated with HT, trauma patients are more likely to survive and/or to be discharged and allowed to go home after treatment [5,8,26]. This delay may be partly due to a more aggressive therapy observed in HMICU compared with GMICU during the pre-hospital phase. "
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The benefits of transporting severely injured patients by helicopter remain controversial. This study aimed to analyze the impact on mortality of helicopter compared to ground transport directly from the scene to a University hospital trauma center.
The French Intensive Care Research for Severe Trauma cohort study enrolled 2,703 patients with severe blunt trauma requiring admission to University hospital intensive care units within 72 hours. Pre-hospital and hospital clinical data, including the mode of transport, (helicopter (HMICU) versus ground (GMICU), both with medical teams), were recorded. The analysis was restricted to patients admitted directly from the scene to a University hospital trauma center. The main endpoint was mortality until ICU discharge.
Of the 1,958 patients analyzed, 74% were transported by GMICU, 26% by HMICU. Median injury severity score (ISS) was 26 (interquartile range (IQR) 19 to 34) for HMICU patients and 25 (IQR 18 to 34) for GMICU patients. Compared to GMICU, HMICU patients had a higher median time frame before hospital admission and were more intensively treated in the pre-hospital phase. Crude mortality until hospital discharge was the same regardless of pre-hospital mode of transport. After adjustment for initial status, the risk of death was significantly lower (odds ratio (OR): 0.68, 95% confidence interval (CI) 0.47 to 0.98, P = 0.035) for HMICU compared with GMICU. This result did not change after further adjustment for ISS and overall surgical procedures.
This study suggests a beneficial impact of helicopter transport on mortality in severe blunt trauma. Whether this association could be due to better management in the pre-hospital phase needs to be more thoroughly assessed.
Critical care (London, England) 09/2012; 16(5):R170. DOI:10.1186/cc11647 · 4.48 Impact Factor
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ABSTRACT: Helicopter emergency medical service (HEMS) crew are subject to various sources of environmental, physical, and psychological stress. We measured the changes in heart rate and blood pressure as indicators of stress among the crewmembers of the regional HEMS of the Region Friuli Venezia Giulia, Italy.
From August 12 to September 3, 2009, and from February 12 to April 1, 2010, heart rate (HR), diastolic blood pressure (DBP), and systolic blood pressure (SBP) were measured, on a voluntary basis, before and after each flight among the crewmembers. Oxygen saturation (SpO(2)) was also recorded. The effects of flight and personal characteristics on the parameters after the flight were analyzed through multivariate regression.
Data on 95 work shifts, corresponding to 162 flights, were collected. Only the HR changed significantly after the flight (median change: 15 beats/min considering all the flights). The increase in HR was significantly greater in flights with adverse weather conditions, in hostile environments, and at high altitude than in the others. The change in HR was inversely correlated with that of SpO(2). After adjusting for potential confounders, the HR after the flight was significantly higher among technical personnel than among physicians and nurses.
The increase in HR after the flight indicates that the HEMS crew are exposed to stressful conditions during the mission. Monitoring such parameters may be helpful in recognizing the onset of acute stress and ensuring the safety of the patients and the crew themselves.
AirMed 09/2011; 30(5):270-5. DOI:10.1016/j.amj.2011.02.002
Available from: Patricio Cortés Picazo
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ABSTRACT: La organización de un Sistema de Atención Prehospitalaria (SAPh) debe obedecer a la realidad sanitaria de un país enfocado hacia el objetivo de brindar oportunidad y calidad en la atención a los pacientes que sufren una urgencia, emergencia y/o desastre en el medio prehospitalario. Es así como el SAPh en Chile, en sus componentes de subsistemas público y privado, ha respondido con un sistema distinto al Americano o al Europeo (FrancoGermano principalmente), es decir, un modelo más bien organizado con múltiples niveles de respuesta desde conductores de reanimación, paramédicos, profesionales universitarios de la salud no médicos y médicos. Además de contar con un eje central que es la regulación médica continua para la administración o gestión del número único de emergencias sanitarias y los limitados recursos disponibles ante la demanda de la comunidad.
09/2011; 22(5):571-584. DOI:10.1016/S0716-8640(11)70468-0
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