Helicopter vs Ground Transportation for Patients With Trauma

ArticleinJAMA The Journal of the American Medical Association 308(6):564-5; author reply 565 · August 2012with7 Reads
DOI: 10.1001/jama.2012.7774 · Source: PubMed
Abstract
To the Editor: The study by Dr Galvagno and colleagues1 focused on the association between helicopter vs ground EMS and survival among patients older than 15 years of age with Injury Severity Scores (ISSs) higher than 15 using the NTDB. While the authors attempted to control and adjust for multiple confounders within their analysis, there remain several areas of concern.Although the authors selected an ISS score of 15 to define their threshold for severe injury (based primarily on work from the 1970s and 1980s2,3), more recent studies4 have demonstrated an ISS score of 8 is a more sensitive threshold to capture equally severe injury. Inclusion of a sensitivity analysis using this lower threshold may have strengthened the analysis.
  • [Show abstract] [Hide abstract] ABSTRACT: Objectives: To investigate the opinions and expectations of residents from Zhejiang Province on the prehospital emergency medical services (EMS). To evaluate the differences among main urban areas, countylevel areas and rural areas in Zhejiang Province. To provide objective data for relevant departments to make further improvement and promote balanced development of the pre-hospital EMS cause. Methods: The study was conducted from 1st April 2011 to 30th December 2011. It was carried out in 11 cities and 1,650 residents were included by stratified random sampling method. The survey mainly focused on residents' expectations of EMS and residents' knowledge of emergency skills, the emergency response time, the actions of EMS dispatchers, the fees charged for EMS. Pearson's Chi-Square Test was also used to compare the differences of the current status and residents' expectations of EMS among main urban areas, county-level areas and rural areas. Results: The survey showed that the top four emergency skills most needed by residents are cardiopulmonary resuscitation (CPR), bandaging to stop bleeding, first aids for heatstroke and drowning. Trauma patients account for 37.5% (95%CI: 35.08-39.92%) of all those who received EMS service, ranking the first place. While the percentage receiving "wound care" was rated as the most needed emergency skill. There were statistically significant differences in the rate of knowing CPR, independently conducting CPR and emergency response time less than 5 minutes among main urban areas, county-level areas and rural areas in Zhejiang Province. Conclusions: Residents of Zhejiang Province lack knowledge and awareness of emergency skills. Their mastery and expectation of emergency skills vary greatly from rural areas to urban areas.Trauma patients have become the main receiver of EMS in these three different regions. The emergency response time, as well as the services provided by EMS dispatchers, is far below the expectation of residents. In addition, the majority of respondents expect EMS to send patients to the nearest hospital and most of the trained paramedics are qualified for the pre-hospital care.
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