1
|
Enomoto Y, Tsutsumi Y, Kido T, Nagatomo K, Tsuchiya A, Inoue Y. Association between helicopter medical services for pediatric trauma patients and mortality: Systematic review and meta-analysis. Am J Emerg Med 2024; 85:196-201. [PMID: 39278027 DOI: 10.1016/j.ajem.2024.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Revised: 09/03/2024] [Accepted: 09/08/2024] [Indexed: 09/17/2024] Open
Abstract
BACKGROUND Helicopter emergency medical services (HEMS) have become widespread around the world. However, previous studies of the influence of HEMS on mortality were limited to adult patients only and showed inconsistent and heterogeneous results. This study aimed to examine the association between HEMS and mortality among pediatric emergencies compared to ground emergency medical service (GEMS). METHODS We searched relevant databases (MEDLINE, EMBASE, The Cochrane Central Register of Controlled Trials) and included articles in any language. The most recent search was on January 4th, 2024. We included prospective observational cohort studies or clinical trials that compared HEMS with GEMS in pediatric patients. We excluded any study that did not compare two or more groups of participants. Two pairs of researchers blindly screened studies and evaluated risk of bias using the Risk of Bias in Nonrandomized Studies of Interventions tool. We conducted this systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Data were extracted by four independent reviewers. We calculated the odds ratio using the random-effects model. The primary outcome was mortality. RESULTS Our search strategy yielded 1454 results. Of these, seven observational studies met our eligibility criteria; no RCT met the criteria. All studies targeted trauma patients only. HEMS was associated with lower mortality (Odds ratio 0.66, 95 % CI 0.59 to 0.74). Inconsistency between trials was determined to be low due to low heterogeneity (I2 = 0 %). In a subgroup analysis conducted with and without physicians on the HEMS staff, we found no significant differences (I2 = 0 %, p = 0.71). CONCLUSION Our systematic review and meta-analysis, which was limited to trauma pediatric trauma patients, revealed that HEMS deployment correlated with decreased mortality. Further research is necessary to more effectively measure the potential influence and applicability of HEMS for pediatric emergencies.
Collapse
Affiliation(s)
- Yuki Enomoto
- Department of Emergency and Critical Care Medicine, University of Tsukuba, Ibaraki, Japan; Department of Pediatrics, University of Tsukuba hospital, Ibaraki, Japan
| | - Yusuke Tsutsumi
- Department of Emergency and Critical Care Medicine, National Hospital Organization Mito Medical Center, Ibaraki, Japan; Human Health Science, Kyoto University Graduate School of Medicine, Kyoto, Japan.
| | - Takahiro Kido
- Department of Pediatrics, University of Tsukuba hospital, Ibaraki, Japan
| | - Kazuki Nagatomo
- Department of Emergency and Critical Care Medicine, University of Tsukuba, Ibaraki, Japan
| | - Asuka Tsuchiya
- Department of Emergency and Critical Care Medicine, Tokai University School of Medicine, Kanagawa, Japan; Department of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yoshiaki Inoue
- Department of Emergency and Critical Care Medicine, University of Tsukuba, Ibaraki, Japan
| |
Collapse
|
2
|
Yobbi A. AHN LifeFlight, 45 Years in the Making: Current Condition and Capabilities of Air Medical Transport. Crit Care Nurs Q 2024; 47:102-110. [PMID: 38419173 DOI: 10.1097/cnq.0000000000000498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
In Pittsburgh, Pennsylvania, the skies have become a battleground against time in a world where every second counts. Since its inception in 1978, a revolution has occurred in emergency medical services, with LifeFlight Helicopters soaring to new heights in emergency treatment and transport. This article will explore the transformation of helicopter emergency medical services through the decades, where every rotor blade spins with a mission to save lives and rewrite the rules of survival. Allegheny Health Network's LifeFlight is a rotor-wing (helicopter) aeromedical transport service that provides rapid emergent transport for critically ill and injured persons. The program hub of operations is primarily in Western Pennsylvania. Since its inception in 1978, the program has grown and transformed into the sophisticated, highly technical, expanded scope of practice, critical care transport service it is today. The crews spend a significant portion of clinical care focusing on preparing the patient to survive the transport and ensure stability during transit; this phase of transport is equally crucial as the patient care during the actual flight. This article introduces the evolution and innovations that LifeFlight's medical crews and aviation practices have undergone since the program started.
Collapse
Affiliation(s)
- Annale Yobbi
- AHN LifeFlight; Allegheny General Hospital, Pittsburgh, Pennsylvania
| |
Collapse
|
3
|
Urdaneta A, Fisk C, Tandel MD, Garcia A, Govindarajan P. Air Medical Transport for Acute Ischemic Stroke Patients: A Retrospective Cohort Study of National Trends Over an 8-Year Period. Air Med J 2023; 42:423-428. [PMID: 37996176 DOI: 10.1016/j.amj.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 06/21/2023] [Indexed: 11/25/2023]
Abstract
OBJECTIVE Optimal management of ischemic stroke is time dependent. An understanding of patterns of air medical transport may identify disparities that could affect patient care. METHODS In this 8-year (2007-2014) observational, retrospective, cohort study, we abstracted a 20% national sample of Medicare data from patients ≥ 66 years of age hospitalized with a primary diagnosis of acute ischemic stroke who presented to the emergency department by ambulance (air or ground). RESULTS Among 149,751 hospitalized stroke patients who arrived by ambulance, the mean age was 81.6 years (standard deviation = 8.0 years), 62.1% were female (n = 93,007), and 86.3% were White (n = 129,268). Of these, 5,534 patients (3.7%) used any form of air ambulance. Air ambulance use (2007: 2.5%, 2014: 4.9%; P < .001) and arrival at certified stroke centers (2007: 40.3%, 2014: 63.2%; P < .001) increased over time. Air ambulance use was less likely among older patients (76-85 years and >85 years vs. 66-75 years; odds ratio [OR] = 0.68; 95% confidence interval [CI], 0.64-0.72 and OR = 0.34; 95% CI, 0.32-0.37, respectively) and all racial minorities except American Natives (OR = 2.07; 95% CI, 1.57-2.73) and more likely among sicker patients (Charlson Comorbidity Index ≥ 2 vs. 1, OR = 1.23; 95% CI, 1.09-1.38) and rural residents (OR = 1.34; 95% CI, 1.09-1.64). After adjustment for covariates, air ambulance use was associated with higher odds of thrombolysis (adjusted OR = 2.57; 95% CI, 2.38-2.79). CONCLUSION Air ambulance use is independently associated with increased thrombolysis use for stroke, but disparities exist in both air ambulance and thrombolysis use. Further research into underlying causes for these disparities would be beneficial for systems and public health-based interventions for improving outcomes for ischemic stroke.
Collapse
Affiliation(s)
- Alfredo Urdaneta
- Department of Emergency Medicine, Stanford Medicine, Palo Alto, CA
| | - Cameron Fisk
- Department of Emergency Medicine, Stanford Medicine, Palo Alto, CA
| | - Megha D Tandel
- Quantitative Sciences Unit, Department of Medicine, Stanford Medicine, Palo Alto, CA
| | - Ariadna Garcia
- Quantitative Sciences Unit, Department of Medicine, Stanford Medicine, Palo Alto, CA
| | | |
Collapse
|
4
|
Hennelly D, Deasy C, Jennings P, O'Donnell C, Masterson S. The Development of Helicopter Emergency Medical Services in the Republic of Ireland. Air Med J 2023; 42:150-156. [PMID: 37150567 DOI: 10.1016/j.amj.2023.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 01/13/2023] [Indexed: 05/09/2023]
Abstract
Helicopter emergency medical services (HEMS) have formed an integral component of the Irish health care system for the past decade; yet, the factors leading their commencement, their evolutions over this time, and the current model of service delivery have not been widely published. Aeromedical service provision may vary significantly from country to country and may also vary regionally within countries. A health system's necessities; capacity and maturity; the level of state, corporate, private, or community investment; and the capacity of the contracted service provider are all factors that influence the service provision. This research article describes the historic factors leading to a military and health system collaboration to HEMS during an era of health care reform. Over the past decade, the Irish health system has undergone significant reconfiguration and centralization of services, leading to increased demands on emergency medical ground and air medical services. Future advancements in aeromedical service provision require an innate understanding of the current model. This article adds to the knowledge base, informs policy makers, and supports decision making surrounding HEMS provision and the potential to explore military and health system collaborations and enhanced overall service provision.
Collapse
Affiliation(s)
- David Hennelly
- National Ambulance Service, Limerick, Ireland; University College Cork, Cork, Ireland.
| | - Conor Deasy
- University College Cork, Cork, Ireland; Cork University Hospital, Cork, Ireland; Southern Trauma Network, Cork, Ireland
| | - Paul Jennings
- Department of Paramedicine, Monash University, Melbourne, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Ambulance Victoria, Melbourne, Australia
| | - Cathal O'Donnell
- National Ambulance Service, Limerick, Ireland; University of Limerick, Centre for Prehospital Research, Graduate Entry Medical School, Limerick, Ireland
| | - Siobhán Masterson
- National University of Ireland Galway, Galway, Ireland; National Ambulance Service, Donegal, Ireland
| |
Collapse
|
5
|
Zachrison KS, Nielsen VM, de la Ossa NP, Madsen TE, Cash RE, Crowe RP, Odom EC, Jauch EC, Adeoye OM, Richards CT. Prehospital Stroke Care Part 1: Emergency Medical Services and the Stroke Systems of Care. Stroke 2023; 54:1138-1147. [PMID: 36444720 PMCID: PMC11050637 DOI: 10.1161/strokeaha.122.039586] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Acute stroke care begins before hospital arrival, and several prehospital factors are critical in influencing overall patient care and poststroke outcomes. This topical review provides an overview of the state of the science on prehospital components of stroke systems of care and how emergency medical services systems may interact in the system to support acute stroke care. Topics include layperson recognition of stroke, prehospital transport strategies, networked stroke care, systems for data integration and real-time feedback, and inequities that exist within and among systems.
Collapse
Affiliation(s)
- Kori S Zachrison
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA (K.S.Z., R.E.C.)
| | | | - Natalia Perez de la Ossa
- Department of Neurology, Stroke Unit, Hospital Universitari Germans Trias I Pujol, Badalona, Spain and Stroke Programme, Catalan Health Department, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (N.P.d.l.O)
| | - Tracy E Madsen
- Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, RI (T.E.M.)
| | - Rebecca E Cash
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA (K.S.Z., R.E.C.)
| | | | - Erika C Odom
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA (E.C.O.)
| | - Edward C Jauch
- Department of Research, University of North Carolina Health Sciences at Mountain Area Health Education Center, Asheville, NC (E.C.J.)
| | - Opeolu M Adeoye
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO (O.M.A.)
| | - Christopher T Richards
- Division of EMS, Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, OH (C.T.R.)
| |
Collapse
|
6
|
Chari SV, Cui ER, Fehl HE, Fernandez AR, Brice JH, Patel MD. Community socioeconomic and urban-rural differences in emergency medical services times for suspected stroke in North Carolina. Am J Emerg Med 2023; 63:120-126. [PMID: 36370608 PMCID: PMC10425758 DOI: 10.1016/j.ajem.2022.10.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 10/19/2022] [Accepted: 10/23/2022] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE Our objectives were to describe time intervals of EMS encounters for suspected stroke patients in North Carolina (NC) and evaluate differences in EMS time intervals by community socioeconomic status (SES) and rurality. METHODS This cross-sectional study used statewide data on EMS encounters of suspected stroke in NC in 2019. Eligible patients were adults requiring EMS transport to a hospital following a 9-1-1 call for stroke-like symptoms. Incident street addresses were geocoded to census tracts and linked to American Community Survey SES data and to rural-urban commuting area (RUCA) codes. Community SES was defined as high, medium, or low based on tertiles of an SES index. Urban, suburban, and rural tracts were defined by RUCA codes 1, 2-6, and 7-10, respectively. Multivariable quantile regression was used to estimate how the median and 90th percentile of EMS time intervals varied by community SES and rurality, adjusting for each other; patient age, gender, and race/ethnicity; and incident characteristics. RESULTS We identified 17,117 eligible EMS encounters of suspected stroke from 2028 census tracts. The population was 65% 65+ years old; 55% female; and 69% Non-Hispanic White. Median response, scene, and transport times were 8 (interquartile range, IQR 6-11) min, 16 (IQR 12-20) min, and 14 (IQR 9-22) minutes, respectively. In quantile regression adjusted for patient demographics, minimal differences were observed for median response and scene times by community SES and rurality. The largest median differences were observed for transport times in rural (6.7 min, 95% CI 5.8, 7.6) and suburban (4.7 min, 95% CI 4.2, 5.1) tracts compared to urban tracts. Adjusted rural-urban differences in 90th percentile transport times were substantially greater (16.0 min, 95% CI 14.5, 17.5). Low SES was modesty associated with shorter median (-3.3 min, 95% CI -3.8, -2.9) and 90th percentile (-3.0 min, 95% CI -4.0, -2.0) transport times compared to high SES tracts. CONCLUSIONS While community-level factors were not strongly associated with EMS response and scene times for stroke, transport times were significantly longer rural tracts and modestly shorter in low SES tracts, accounting for patient demographics. Further research is needed on the role of community socioeconomic deprivation and rurality in contributing to delays in prehospital stroke care.
Collapse
Affiliation(s)
- Srihari V Chari
- Department of Emergency Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Eric R Cui
- Department of Emergency Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Haylie E Fehl
- Department of Emergency Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Antonio R Fernandez
- Department of Emergency Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA; ESO, Austin, TX, USA
| | - Jane H Brice
- Department of Emergency Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Mehul D Patel
- Department of Emergency Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA.
| |
Collapse
|