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Vianen NJ, Campfens JR, Brouwer-Bergsma M, Van Ditshuizen JC, Giannakopoulos GF, Hoogerwerf N, den Hartog D, Van Lieshout EMM, Maissan IM, Schober P, Venema L, Verhofstad MHJ, Van Vledder MG. Establishing Outcome Parameters for Helicopter Emergency Medical Services Research in the Netherlands: Results of a Mixed-Methods Delphi Consensus Study. PREHOSP EMERG CARE 2024:1-18. [PMID: 39378178 DOI: 10.1080/10903127.2024.2413038] [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: 04/05/2024] [Revised: 09/05/2024] [Accepted: 09/27/2024] [Indexed: 10/10/2024]
Abstract
OBJECTIVES Physician staffed Helicopter Emergency Medical Services (P-HEMS) care in the Netherlands has transitioned from predominantly trauma management to handling a variety of medical conditions. Relevant outcome parameters for Dutch P-HEMS research have not been previously defined. National consensus was sought to identify relevant long term patient outcome parameters, process outcome parameters and performance outcome parameters for Dutch P-HEMS care. METHODS This was a mixed methods Delphi consensus study. A list of potentially relevant outcome parameters was identified using a systematic literature review. These parameters were subsequently surveyed in a Delphi consensus study. Helicopter Emergency Medical Services physicians and relevant stakeholders were invited to participate in this Delphi survey, where they were allowed to suggest additional outcome parameters. Descriptive analysis was performed on all data sets. RESULTS Forty-nine potential outcome parameters for Dutch P-HEMS care were surveyed. Of 71 invited participants, 53 (75%), 40 (56%), and 20 (28%) participated in the first, second, and third round of the Delphi study, respectively. Consensus was reached on 25 (51%) of 49 outcome parameters as being important. These consisted of seven long term patient related outcome parameters, four short term patient related outcome parameters, five process outcome parameters and nine performance outcome parameters. CONCLUSIONS In conclusion, this study identified 25 outcome parameters relevant for Dutch physician staffed HEMS care. These parameters should be considered when designing future studies and should be routinely collected for each dispatch if possible.
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Affiliation(s)
- Niek J Vianen
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - J Reinout Campfens
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Margot Brouwer-Bergsma
- Department of Anesthesiology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Jan C Van Ditshuizen
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Trauma Centre Southwest Netherlands, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Georgios F Giannakopoulos
- Department of Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Nico Hoogerwerf
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Dennis den Hartog
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Esther M M Van Lieshout
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Iscander M Maissan
- Department of Anesthesiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Patrick Schober
- Department of Anesthesiology, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Lieneke Venema
- Department of Anesthesiology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Michael H J Verhofstad
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Mark G Van Vledder
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Fritz CL, Thomas SA, Galvagno SM, Thomas SH. Survival Benefit of Helicopter Scene Response for Patients with an Injury Severity Score of at Least Nine: A Systematic Review and Meta-Analysis. PREHOSP EMERG CARE 2023; 28:841-850. [PMID: 37406174 DOI: 10.1080/10903127.2023.2232453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 05/08/2023] [Accepted: 06/26/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND AND AIM Helicopter EMS (HEMS) is a well-established mode of rapid transportation for patients with need for time-sensitive interventions, especially in patients with significant traumatic injuries. Traditionally in the setting of trauma, HEMS is often considered appropriate when used for patients with "severe" injury as defined by Injury Severity Score (ISS) >15. This may be overly conservative, and patients with a lower ISS may benefit from HEMS-associated speed or care quality. Our objective was to perform a meta-analysis of trauma HEMS transports to evaluate for possible mortality benefit in injured cases defined by an ISS score >8, lower than the customary ISS cutoff of >15. METHODS A broad search of the literature was performed including PubMed, EMBASE, SCOPUS, Cochrane Central Register of Controlled Trials, and Google Scholar from the years 1970 to 2022. The gray literature and reference lists of included publications were also examined. We included studies with the outcome of mortality in HEMS vs control in trauma transports from scene of injury for patients (adult or pediatric) with ISS > 8. RESULTS Nine eligible studies were used in the final analysis: six in the primary analysis and three in sensitivity analysis due to patient overlap. All studies reported statistically significant survival benefit in HEMS compared to control group. The minimum survival odds ratio (OR) benefit observed was OR 1.15 (95% CI 1.06-1.25) and maximum was OR 2.04 (95% CI 1.18-3.57). Risk of bias tool (ROBINS-I) application yielded moderate to low risk of bias, mainly due to the observational nature of the studies included. CONCLUSIONS There was a statistically significant survival benefit in patients with ISS > 8 when HEMS was used over traditional ground ambulance transportation, although novel and more inclusive trauma triage criteria may be more appropriate in the future to guide HEMS utilization decision-making. Restricting HEMS to trauma patients with ISS >15 likely misses survival benefit that could be afforded to the subset of trauma patients with serious injury.
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Affiliation(s)
- Christie L Fritz
- EMS Division, Department of Emergency Medicine, Beth Israel Deaconess Medical Center & Harvard Medical School, Boston, Massachusetts
| | - Sarah Alice Thomas
- Department of Molecular Microbiology & Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Samuel M Galvagno
- Department of Anesthesiology, University of Maryland School of Medicine & R. Adams Cowley Shock Trauma Center, Baltimore, Maryland
- Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - Stephen H Thomas
- EMS Division, Department of Emergency Medicine, Beth Israel Deaconess Medical Center & Harvard Medical School, Boston, Massachusetts
- Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
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Thomas SH, Thomas SW, Thomas SA, Pathan S. Helicopter Emergency Medical Services Literature 1972-2017: Characteristics and Trends. Air Med J 2019; 38:115-124. [PMID: 30898282 DOI: 10.1016/j.amj.2018.11.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 11/21/2018] [Indexed: 11/16/2022]
Abstract
Since its inception in the latter part of the 20th century, the rapid expansion of helicopter emergency medical services (HEMS) has been accompanied by remarkable growth in the relevant evidence base. There are many review articles describing lessons contained within the various arenas of HEMS literature, but there is little or no characterization of the numbers and types of publications comprising the HEMS-related evidence base. This study analyzed all indexed publications mentioning HEMS (with abstract included) in the United States National Library of Medicine's PubMed collection. The aims of the analysis were to provide quantitative, qualitative, and longitudinal trend information regarding the 1972 to 2017 evidence base relevant to HEMS.
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Affiliation(s)
- Stephen H Thomas
- Weill Cornell Medical College, Doha, Qatar; University of London, London, United Kingdom; Department of Emergency Medicine, Hamad General Hospital, Doha, Qatar.
| | | | | | - Sameer Pathan
- Department of Emergency Medicine, Hamad General Hospital, Doha, Qatar
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