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Marlor D, Juang D, Pruitt L, Cruz-Centeno N, Stewart S, Senna J, Flint J. Factors Associated With Early Discharge in Pediatric Trauma Patients Transported by Rotor: A Retrospective Analysis. Air Med J 2024; 43:37-41. [PMID: 38154838 DOI: 10.1016/j.amj.2023.09.010] [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: 07/04/2023] [Revised: 09/19/2023] [Accepted: 09/21/2023] [Indexed: 12/30/2023]
Abstract
OBJECTIVE Helicopter emergency medical services (HEMS) play a crucial role in providing timely transport for pediatric trauma patients. This service carries the highest risk of any mode of medical transport and a high financial burden, and patient outcomes are seldom investigated. This study evaluated the characteristics of pediatric trauma patients discharged within 24 hours after transport by HEMS. METHODS This was a single-center, retrospective analysis on pediatric trauma patients transported by HEMS from 2019 to 2022. Analyses were performed to identify factors associated with discharge within 24 hours. Factors analyzed included vital signs, Shock Index, Pediatric Age-Adjusted scores, management details, and clinical outcomes. RESULTS A total of 466 pediatric trauma patients were transported by HEMS, including 171 patients (36.7%) who were discharged within 24 hours. There were no differences in the rates of blunt and penetrating injury (P = .583). Patients discharged within 24 hours were more likely to have a higher Glasgow Coma Scale score (14 vs. 11, P < .001) and a lower Injury Severity Score (4.9 vs. 14.7, P < .001), required less prehospital fluid resuscitation (5.5 vs. 11.7 mL/kg, P = .039), and had higher levels of serum calcium (9.3 vs. 8.9 mg/dL, P < .001). They were also less likely to meet criteria for level 1 trauma activation (13.0% vs. 40%, P < .001) or to require prehospital respiratory support of any kind (4.1% vs. 31.1%, P < .001). After arrival at the hospital, they were less likely to require blood transfusions (2.9% vs. 29.8%, P < .001) or tranexamic acid (2.9% vs. 11.5%, P = .001). CONCLUSION Trauma patients with a high Glasgow Coma Scale score and a low Injury Severity Score who do not require critical care or meet the criteria for high-level trauma activation may be suitable for transportation with lower acuity. Further studies aimed at improving triage and implementing improved criteria for the use of HEMS are paramount.
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Affiliation(s)
| | | | | | | | | | - Jack Senna
- Kansas City University School of Medicine, Kansas City, MO
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2
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Rhodes H, Poulin SR, Pepe A. Clinical Impact of Prolonged Helicopter Emergency Travel Times in a Rural Trauma System. Am Surg 2023; 89:5292-5296. [PMID: 36529455 DOI: 10.1177/00031348221146955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Abstract
BACKGROUND In the United States, healthcare organizations utilize helicopter emergency medical services (HEMS), which are well-established and integral to trauma and emergency medical transport. HEMS expedites critical resources to trauma patients at the initial scene of the accident, which typically falls outside of the effective service area of ground transportation. METHODS This is a single-center study of trauma registry data, inclusive years July 1, 2016, to September 26, 2021. The inclusion criteria were all adult ICU patients (≥18 years) traveling by air. An initial bivariate analysis was used to describe differences in HEMS vs rendezvous (ground + HEMS) mode of arrival. A multivariate linear regression was calculated to predict elapsed transport times on predictor variables to determine the clinical impact of prolonged transport times. RESULTS There were 242 patients identified in the analysis, with 87 (36%) traveling by HEMS and 155 (64%) traveling by rendezvous. A significant regression equation was found (F(29,198) = 2.39, P < .01), with an R2 of .26. As the transport time increased by 10.67 minutes, the shock index ratio (SIR) increased by one unit (P = .04). Conversely, for each unit increase in Glasgow Coma Scores (GCS), flight time decreased by 1.03 minutes (P < .01). Rendezvous transport times were on average eight minutes longer than HEMS alone (P < .01). CONCLUSIONS Those with prolonged travel times were likely to travel by rendezvous with presentation of lower GCS and higher SIR upon arrival, despite equivocal injury patterns and severity. This research highlights the need for a helicopter auto-launch program to expedite helicopter travel times in distant locations to the only Level I trauma center in the region.
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Affiliation(s)
- Heather Rhodes
- Department of Surgery, Grand Strand Medical Center, Myrtle Beach, SC, USA
| | - Stephen R Poulin
- School of Social Work Northern Kentucky University, Highland Heights, KY, USA
| | - Antonio Pepe
- Department of Surgery, Grand Strand Medical Center, Myrtle Beach, SC, USA
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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 2023:1-15. [PMID: 37406174 DOI: 10.1080/10903127.2023.2232453] [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: 03/08/2023] [Revised: 05/08/2023] [Accepted: 06/26/2023] [Indexed: 07/07/2023]
Abstract
Background and AimHelicopter 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.MethodsA 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.ResultsNine 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.ConclusionsThere 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 USA
| | - Sarah Alice Thomas
- Department of Molecular Microbiology & Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland USA
| | - Samuel M Galvagno
- Department of Anesthesiology, University of Maryland School of Medicine & R. Adams Cowley Shock Trauma Center, Baltimore, Maryland USA
- Barts and The London School of Medicine & Dentistry, Queen Mary University of London, UK
| | - Stephen H Thomas
- EMS Division, Department of Emergency Medicine, Beth Israel Deaconess Medical Center & Harvard Medical School, Boston, Massachusetts USA
- Barts and The London School of Medicine & Dentistry, Queen Mary University of London, UK
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4
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Fuchs A, Huber M, Riva T, Becker S, Albrecht R, Greif R, Pietsch U. Factors influencing on-scene time in a physician-staffed helicopter emergency medical service (HEMS): a retrospective observational study. Scand J Trauma Resusc Emerg Med 2023; 31:20. [PMID: 37060088 PMCID: PMC10105469 DOI: 10.1186/s13049-023-01085-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 04/06/2023] [Indexed: 04/16/2023] Open
Abstract
BACKGROUND For helicopter emergency service systems (HEMS), the prehospital time consists of response time, on-scene time and transport time. Little is known about the factors that influence on-scene time or about differences between adult and paediatric missions in a physician-staffed HEMS. METHODS We analysed the HEMS electronic database of Swiss Air-Rescue from 01-01-2011 to 31-12-2021 (N = 110,331). We included primary missions and excluded missions with National Advisory Committee for Aeronautics score (NACA) score 0 or 7, resulting in 68,333 missions for analysis. The primary endpoint 'on-scene time' was defined as first physical contact with the patient until take-off to the hospital. A multivariable linear regression model was computed to examine the association of diagnosis, type and number of interventions and monitoring, and patient's characteristics with the primary endpoint. RESULTS The prehospital time and on-scene time of the missions studied were, respectively, 50.6 [IQR: 41.0-62.0] minutes and 21.0 [IQR: 15.0-28.6] minutes. Helicopter hoist operations, resuscitation, airway management, critical interventions, remote location, night-time, and paediatric patients were associated with longer on-scene times. CONCLUSIONS Compared to adult patients, the adjusted on-scene time for paediatric patients was longer. Besides the strong impact of a helicopter hoist operation on on-scene time, the dominant factors contributing to on-scene time are the type and number of interventions and monitoring: improving individual interventions or performing them in parallel may offer great potential for reducing on-scene time. However, multiple clinical interventions and monitoring interact and are not single interventions. Compared to the impact of interventions, non-modifiable factors, such as NACA score, type of diagnosis and age, make only a minor contribution to overall on-scene time.
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Affiliation(s)
- Alexander Fuchs
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland.
- Swiss Air-Rescue (Rega), Zurich, Switzerland.
| | - Markus Huber
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Thomas Riva
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | | | - Roland Albrecht
- Swiss Air-Rescue (Rega), Zurich, Switzerland
- Department of Anaesthesiology and Intensive Care Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Robert Greif
- University of Bern, Bern, Switzerland
- School of Medicine, Sigmund Freud University Vienna, Vienna, Austria
- European Resuscitation Council (ERC) Research NET, Niel, Belgium
| | - Urs Pietsch
- Swiss Air-Rescue (Rega), Zurich, Switzerland
- Department of Anaesthesiology and Intensive Care Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Patterson KN, Beyene TJ, Bergus K, Stafford J, Wurster L, Thakkar RK. Interfacility helicopter transport to a tertiary pediatric trauma center. J Pediatr Surg 2022; 57:637-643. [PMID: 35672168 DOI: 10.1016/j.jpedsurg.2022.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 04/19/2022] [Accepted: 05/11/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Helicopter emergency medical services (HEMS) are intended to expedite care to definitive management. Studies are inconclusive in demonstrating appropriate use. We aimed to examine emergent interventions after interfacility helicopter transport (IHT) to our pediatric trauma center. METHODS Trauma patients 0-18 years undergoing IHT or interfacility ground transport (IGT) to our institution from January 2011-December 2020 were studied. We evaluated the rate of IHT patients undergoing emergent (1 h), urgent (6 h), and semi urgent (48 h) operating room (OR) intervention compared to IGT as a measure of appropriate transport. RESULTS Inclusion was met by 1003 IHT and 7829 IGT patients. OR intervention was required in 29.6% of IHT patients, emergent in 1.3%, urgent in 12.6%, and semi urgent in 10.6%. Overall, IHT patients had higher mean injury severity score (ISS; IHT:14.5; SD:11.0 vs. IGT:6.0; SD:5.0; p < 0.01) and lower GCS (IHT:12.0; SD:4.9 vs. IGT:14.8; SD:1.4; p < 0.01), though over triage (ISS ≤ 15) occurred in 67.9% of patients. CONCLUSION More interfacility helicopter transport patients underwent emergent and urgent procedures compared to interfacility ground transport patients; however, emergent intervention was not required in 98.7% of interfacility helicopter transport patients and over two thirds had ISS ≤ 15, possibly suggesting overutilization of interfacility helicopter transport for pediatric trauma patients at our center. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Kelli N Patterson
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA
| | - Tariku J Beyene
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA
| | - Katherine Bergus
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA
| | - Jordan Stafford
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA
| | - LeeAnn Wurster
- Center for Pediatric Trauma Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA
| | - Rajan K Thakkar
- Division of Pediatric Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA; Center for Pediatric Trauma Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA.
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Joseph AM, Horvat CM, Evans IV, Kuch BA, Kahn JM. Helicopter versus ground ambulance transport for interfacility transfer of critically ill children. Am J Emerg Med 2022; 61:44-51. [PMID: 36037589 DOI: 10.1016/j.ajem.2022.08.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 08/07/2022] [Accepted: 08/14/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Following initial stabilization, critically ill children often require transfer to a specialized pediatric hospital. While the use of specialized pediatric transport teams has been associated with improved outcomes for these patients, the additional influence of transfer mode (helicopter or ground ambulance) on clinical outcomes remains unknown. METHODS We investigated the association between transport mode and outcomes among critically ill children transferred to a single pediatric hospital via a specialized pediatric transport team. We designed a retrospective cohort study to reduce indication bias by limiting analysis to patients for whom a helicopter transport was initially requested. We compared outcomes for those who ultimately traveled via helicopter, and for those who ultimately traveled via ground ambulance due to non-clinical factors. RESULTS We compared transport times, in-hospital mortality, and hospital length of stay by transport mode. Transport time in minutes was shorter for helicopter transports (median = 143, interquartile range [IQR]: 118-184) compared to ground ambulance transports (median = 289, IQR: 213-258; difference in medians = 146, 95% CI: 12 to 168, p < 0.001). In unadjusted analysis, helicopter transport was not associated with a difference in in-hospital mortality (helicopter = 6.0%, ground ambulance = 7.0%; 95% CI for difference: -6.6% to 3.3%; p = 0.64) but was associated with a statistically significant reduction in median hospital days (helicopter = 4, ground ambulance = 5; 95% CI -3 to 0; p = 0.04). In adjusted analyses, there were no statistically significant associations. These results were consistent across sensitivity analyses. CONCLUSIONS Among critically ill pediatric patients without traumatic injuries transported by a specialty team, those patients who would have been transferred by helicopter if available but were instead transferred by ground ambulance reached their site of definitive care approximately 2.5 h later. Helicopter transport for these patients was not associated with in-hospital mortality, but was potentially associated with reduced hospital length of stay.
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Affiliation(s)
- Allan M Joseph
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America; UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, United States of America.
| | - Christopher M Horvat
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America; UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, United States of America.
| | - Idris V Evans
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America; UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, United States of America.
| | - Bradley A Kuch
- Center for Emergency Medicine of Western Pennsylvania and STAT MedEvac, Pittsburgh, PA, United States of America.
| | - Jeremy M Kahn
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America; Department of Health Policy & Management, University of Pittsburgh School of Public Health, Pittsburgh, PA, United States of America.
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Nielsen VM, Bruun NH, Søvsø MB, Kløjgård TA, Lossius HM, Bender L, Mikkelsen S, Tarpgaard M, Petersen JA, Christensen EF. Pediatric Emergencies in Helicopter Emergency Medical Services: A National Population-Based Cohort Study From Denmark. Ann Emerg Med 2022; 80:143-153. [DOI: 10.1016/j.annemergmed.2022.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 03/25/2022] [Accepted: 03/28/2022] [Indexed: 11/28/2022]
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Overutilization of Helicopter Emergency Medical Services in Central Gulf Coast Region Results in Unnecessary Expenditure. J Surg Res 2022; 273:211-217. [DOI: 10.1016/j.jss.2021.12.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 10/25/2021] [Accepted: 12/15/2021] [Indexed: 11/23/2022]
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Colbachini PCM, Marson FAL, Peixoto AO, Sarti L, Fraga AMA. Air Rescue for Pediatric Trauma in a Metropolitan Region of Brazil: Profiles, Outcomes, and Overtriage Rates. Front Pediatr 2022; 10:890405. [PMID: 35722501 PMCID: PMC9201391 DOI: 10.3389/fped.2022.890405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 04/20/2022] [Indexed: 11/13/2022] Open
Abstract
Besides ensuring a quick response and transport of trauma victims, helicopter support also involves risks to patients and professionals and has higher operational costs. Studying prehospital triage criteria and their relationship with patient overtriage and outcomes is important, particularly in newly established services and in developing countries with limited health budgets. This could help improve the use of the helicopter rescue and provide better management of the costs and risks related to it. The objective of this study was to determine the epidemiologic and severity profiles of pediatric victims of trauma attended by helicopter in a Brazilian Metropolitan Area to evaluate the outcomes and overtriage rates related to pediatric air rescue in the region. We conducted an observational and retrospective study using 49 hospital and prehospital records from victims of trauma aged <18 years old (yo) assisted by helicopter and then transferred to a tertiary University Hospital. Of the 49 patients, 39 (79.6%) individuals were male, and the mean age was 11.3 yo. Vehicular collisions accounted for 15 (30.6%) of the traumas, and traumatic brain injuries occurred in 28 (57.1%) cases. A total of 29 (59.1%) individuals had severe trauma (Injury Severity Score; ISS >15), and 34 (69.4%) required admission to the intensive care unit. Overtriage varied from 18.4 to 40.8% depending on the criteria used for its definition, being more frequent in individuals aged between 1 and 5 yo. Death occurred in 10 (20.4%) patients. On prehospital evaluation, we classified 29/32 (90.6%) patients with severe trauma according to the Pediatric Trauma Score (PTS ≤8) and 18/25 (72%) according to the Revised Trauma Score (RTS ≤11). Of these, 7/29 (24.1%) and 6/18 (33.3%), respectively, presented ISS <15 at in-hospital evaluation. None of the patients with PTS >8 and 3/7 (42.8%) of those with RTS >11 presented ISS >15. In conclusion, air rescue of pediatric trauma victims was used mainly for critically ill individuals, resulting in rates of overtriage compatible with that found in the literature. PTS showed the lowest rates of overtriage within excellent rates of undertriage.
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Affiliation(s)
- Paulo C M Colbachini
- Postgraduate Program in Child and Adolescent Health, Department of Pediatrics, University of Campinas, Campinas, Brazil
| | - Fernando A L Marson
- Postgraduate Program in Child and Adolescent Health, Department of Pediatrics, University of Campinas, Campinas, Brazil.,Laboratory of Medical Genetics and Human Genetics, Postgraduate Program in Health Sciences, Health Sciences Department, São Francisco University, Bragança Paulista, Brazil
| | - Andressa O Peixoto
- Postgraduate Program in Child and Adolescent Health, Department of Pediatrics, University of Campinas, Campinas, Brazil
| | - Luisa Sarti
- Faculty of Medical Sciences, Clinical Hospital of University of Campinas, University of Campinas, Campinas, Brazil
| | - Andrea M A Fraga
- Postgraduate Program in Child and Adolescent Health, Department of Pediatrics, University of Campinas, Campinas, Brazil
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Duffens A, Grigorian A, de Virgilio C, Chin T, Kim D, Lekawa M, Schubl SD, Nahmias J. Association of Risk of Mortality in Pediatric Patients Transferred From Scene by Helicopter With Major But Not Minor Injuries. Pediatr Emerg Care 2022; 38:e287-e291. [PMID: 33105460 DOI: 10.1097/pec.0000000000002263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Helicopter emergency medical services (HEMS) are used for 16% of pediatric trauma. National HEMS guidelines advised that triage criteria be standardized for pediatric patients. A national report found pediatric HEMS associated with decreased mortality compared with ground emergency medical services (GEMS) but did not control for transport time. We hypothesized that the rate of HEMS has decreased nationally and the mortality risk for HEMS to be similar when adjusting for transport time compared with GEMS. METHODS The Pediatric Trauma Quality Improvement Program (2014-2016) was queried for patients younger than 16 years transported by HEMS or GEMS. A multivariable logistic regression was used. RESULTS From 25,647 patients, 4527 (17.7%) underwent HEMS. The rate of HEMS from scene decreased from 21.2% in 2014 to 18.2% in 2016. The rate of HEMS for minor trauma (Injury Severity Score <15) decreased from 14.9% in 2014 to 13.5% in 2016 and major trauma (Injury Severity Score > 15) from 38.4% in 2014 to 35.9% in 2016. After controlling for predictors of mortality and transport time, HEMS was associated with decreased risk of mortality for only those with major injuries transferred from scene (odds ratio, 0.48; 95% confidence interval, 0.26-0.88; P = 0.01) compared with GEMS. CONCLUSIONS The rate of HEMS in pediatric trauma has decreased. However, there is room for improvement as 14% of those with minor trauma are transported by HEMS. Given the similar risk of mortality compared with GEMS, further development of guidelines that avoid the unnecessary use of HEMS appears warranted. However, utilization of HEMS for transport of pediatric major trauma should continue.
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Affiliation(s)
- Ali Duffens
- From the Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine, Orange
| | - Areg Grigorian
- From the Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine, Orange
| | | | - Theresa Chin
- From the Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine, Orange
| | - Dennis Kim
- Department of Surgery, Harbor-University of California, Los Angeles, Torrance, CA
| | - Michael Lekawa
- From the Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine, Orange
| | - Sebastian D Schubl
- From the Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine, Orange
| | - Jeffry Nahmias
- From the Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine, Orange
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11
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Enomoto Y, Tsuchiya A, Tsutsumi Y, Kikuchi H, Ishigami K, Osone J, Togo M, Yasuda S, Inoue Y. Characteristics of Children Cared for by a Physician-Staffed Helicopter Emergency Medical Service. Pediatr Emerg Care 2021; 37:365-370. [PMID: 30211837 DOI: 10.1097/pec.0000000000001608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVES The effectiveness of Japanese helicopter emergency medical services (HEMS) and interventions at the scene is not clear as regard children. For effective use of HEMS at the clinical scene, we need to clarify the characteristics of pediatric patients cared for by HEMS. Therefore, the objective of this study was to describe the characteristics of pediatric scene flights and to describe the procedures performed on the patients. METHODS This was a retrospective cohort study based on the database for children aged younger than 18 years who were cared for by physician-staffed HEMS of Ibaraki prefecture, in Japan. We reviewed the database for air medical transports conducted at our institution from July 2010 to December 2016. RESULTS During the 6.5-year period, the Ibaraki HEMS attended to 288 children. The median age of the children was 11 (interquartile range, 5-14) years. Of the total, 196 (68.1%) of the children had trauma-related injuries. The head was the most common site of significant injuries (12.4%). The most common cause of nontrauma incidents was seizure (9.0%). In 65.9% of the patients, the injury or illness was of mild or moderate severity at the scene. An intervention was applied at the scene in 76.0% of the cases: 75.1%, intravenous route; 6.9%, intubation; and 13.4%, drug administration. Of those patients, 29.1% were discharged from the emergency department. In-hospital mortality accounted for 1.5% (n = 2) of the cases. CONCLUSIONS Although the condition at the scene of most of the pediatric patients transported by the physician-staffed HEMS was not severe, an intervention was frequently applied from the scene. Improving the dispatch criteria and monitoring compliance are needed for appropriate use of HEMS.
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Affiliation(s)
| | | | - Yusuke Tsutsumi
- From the Department of Emergency and Critical Care Medicine, National Hospital Organization Mito Medical Center
| | - Hitoshi Kikuchi
- Department of Emergency and Critical Care Medicine, Mito Saiseikai General Hospital, Ibaraki, Japan
| | - Koji Ishigami
- From the Department of Emergency and Critical Care Medicine, National Hospital Organization Mito Medical Center
| | - Junpei Osone
- From the Department of Emergency and Critical Care Medicine, National Hospital Organization Mito Medical Center
| | - Masahito Togo
- From the Department of Emergency and Critical Care Medicine, National Hospital Organization Mito Medical Center
| | - Susumu Yasuda
- From the Department of Emergency and Critical Care Medicine, National Hospital Organization Mito Medical Center
| | - Yoshiaki Inoue
- Department of Emergency and Critical Care Medicine, Tsukuba University Hospital, Ibaraki
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12
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Choi PM, Fraser J, Briggs KB, Dekonenko C, Aguayo P, Juang D. Air transportation over-utilization in pediatric trauma patients. J Pediatr Surg 2021; 56:1035-1038. [PMID: 33008637 DOI: 10.1016/j.jpedsurg.2020.08.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 08/12/2020] [Accepted: 08/27/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Air transportation can be a life-saving transfer modality for trauma patients. However, it is also costly and carries risk for air-crews and patients. We sought to examine the incidence of air transportation among pediatric trauma patients as well as the rate of over-triage in utilizing this intervention. METHODS We conducted a single-institution retrospective review of all pediatric trauma patients who utilized air transportation, either from scene to hospital or hospital to hospital Emergency Department (ED) transfers, between 2013 and 2018. RESULTS There were 348 pediatric trauma patients who utilized air transport. More than half of all patients (n = 186, 55.9%) were discharged from the hospital within 48 h, 121 (36.3%) were discharged within 24 h, and 34 (10.2%) were discharged home from the ED. The mean ISS was 11.2 ± 0.5 while only 31% had an ISS ≥15. There were 97 patients (27.9%) with elevated age adjusted shock index, and 101 patients (29.0%) who required time sensitive interventions. More than half of patients (59.3%) were initially taken to an outside hospital (OSH) and were then transferred to our facility by air while 40.4% were transported directly from scene to our institution by air. Patients who were transferred from an OSH were younger (6.8 ± 0.4 vs 11.2 ± 0.4, p < 0.01) and had a higher incidence of an elevated age-adjusted shock index (32.4% vs 19.1%, p = 0.006) as well as mortality (6.3% vs 1.4%, p = 0.03). However, ultimately there were no differences in ISS, rates of operative intervention, PICU utilization, or time sensitive intervention. Both groups had similarly high rates of discharge within 48 h, 24 h, and from the ED. CONCLUSIONS Air transportation among pediatric trauma patients from scene to hospital and hospital to hospital is over-utilized based on multiple metrics including low rates of ISS ≥15, elevated age-adjusted shock indexes, low rates of time sensitive intervention, as well as high rates of discharge within 24 and 48 h. LEVEL OF EVIDENCE III TYPE OF STUDY: Clinical Research-retrospective review.
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Affiliation(s)
- Pamela M Choi
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, MO 64108; LCDR, US Navy, Navy Medicine Professional Development Center, Bethesda, MD 20889
| | - James Fraser
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, MO 64108
| | - Kayla B Briggs
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, MO 64108
| | - Charlene Dekonenko
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, MO 64108
| | - Pablo Aguayo
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, MO 64108
| | - David Juang
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, MO 64108.
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Helicopter Emergency Medical Service and Hospital Treatment Levels Affect Survival in Pediatric Trauma Patients. J Clin Med 2021; 10:jcm10040837. [PMID: 33670679 PMCID: PMC7922049 DOI: 10.3390/jcm10040837] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 02/13/2021] [Accepted: 02/14/2021] [Indexed: 11/24/2022] Open
Abstract
(1) Background: Data on the effects of helicopter emergency medical service (HEMS) transport and treatment on the survival of severely injured pediatric patients in high-level trauma centers remain unclear. (2) Methods: A national dataset from the TraumaRegister DGU® was used to retrospectively compare the mortality rates among severely injured pediatric patients (1–15 years) who were transported by HEMS to those transported by ground emergency medical service (GEMS) and treated at trauma centers of different treatment levels (levels I–III). (3) Results: In total, 2755 pediatric trauma patients (age: 9.0 ± 4.8 years) were included in this study over five years. Transportation by HEMS resulted in a significant survival benefit compared to GEMS (odds ratio (OR) 0.489; 95% confidence interval (CI): 0.282–0.850). Pediatric trauma patients treated in level II or III trauma centers showed 34% and fourfold higher in-hospital mortality risk than those in level I trauma centers (level II: OR 1.34, 95% CI: 0.70–2.56; level III: OR 4.63, 95% CI: 1.33–16.09). (4) Conclusions: In our national pediatric trauma cohort, both HEMS transportation and treatment in level I trauma centers were independent factors of improved survival in pediatric trauma patients.
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Oude Alink MB, Moors XRJ, Karrar S, Houmes RJ, Hartog DD, Stolker RJ. Characteristics, management and outcome of prehospital pediatric emergencies by a Dutch HEMS. Eur J Trauma Emerg Surg 2021; 48:989-998. [PMID: 33543366 PMCID: PMC9001565 DOI: 10.1007/s00068-020-01579-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 12/16/2020] [Indexed: 11/28/2022]
Abstract
Background In prehospital care, the Helicopter Emergency Medical Service (HEMS) can be dispatched for critically injured or ill children. However, little detail is known about dispatches for children, in terms of the incidence of prehospital interventions and overall mortality. The primary objective of this study is to provide an overview of pediatric patient characteristics and incidence of interventions. Methods A retrospective chart review of all patients ≤ 17 years who received medical care by Rotterdam HEMS from 2012 until 2017 was carried out. Results During the study period, 1905 pediatric patients were included. 59.1% of patients were male and mean age was 6.1 years with 53.2% of patients aged ≤ 3 years. 53.6% were traumatic patients and 49.7% were non-traumatic patients. 18.8% of patients were intubated. Surgical procedures were performed in 0.9%. Medication was administered in 58.1% of patients. Cardiopulmonary resuscitation (CPR) was necessary in 12.9% of patients, 19.9% were admitted to the intensive care unit and 14.0% needed mechanical ventilation. Overall mortality was 9.5%. Mortality in trauma patients was 5.5% and in non-trauma group 15.3%. 3.9% of patients died at the scene. Conclusions Patients attended by HEMS are at high risk of prehospital interventions like CPR or intubation. EMS has little exposure to critically ill or injured children. Hence, HEMS expertise is required to perform critical procedures. Trauma patients had higher survival rates than non-traumatic patients. This may be explained by underlying illnesses in non-traumatic patients and CPR as reason for dispatch. Further research is needed to identify options for improving prehospital care in the non trauma pediatric patients.
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Affiliation(s)
- Michelle Berdien Oude Alink
- Department of Anesthesiology, Erasmus University Medical Center-Sophia Children's Hospital Rotterdam, Rotterdam, The Netherlands. .,Department of Pediatric Anesthesiology, Erasmus University Medical Center Rotterdam-Sophia Children's Hospital, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
| | - Xavier Roland Johnny Moors
- Department of Anesthesiology, Erasmus University Medical Center-Sophia Children's Hospital Rotterdam, Rotterdam, The Netherlands.,HEMS, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Senned Karrar
- Department of Anesthesiology, Erasmus University Medical Center-Sophia Children's Hospital Rotterdam, Rotterdam, The Netherlands
| | - Robert Jan Houmes
- HEMS, Erasmus University Medical Center, Rotterdam, The Netherlands.,Intensive Care and Department of Pediatric Surgery, Erasmus University Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Dennis Den Hartog
- Department of Surgery-Traumatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Robert Jan Stolker
- Department of Anesthesiology, Erasmus University Medical Center-Sophia Children's Hospital Rotterdam, Rotterdam, The Netherlands
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15
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Elkbuli A, Dowd B, Sanchez C, Shaikh S, Sutherland M, McKenney M. Emergency Medical Service Transport Time and Trauma Outcomes at an Urban Level 1 Trauma Center: Evaluation of Prehospital Emergency Medical Service Response. Am Surg 2021; 88:1090-1096. [PMID: 33517710 DOI: 10.1177/0003134820988827] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The use of helicopter emergency medical services (HEMS) for trauma patients has been debated since its introduction. We aim to compare outcomes for trauma patients transported by ground EMS (GEMS) vs. HEMS using raw and adjusted mortality in a level 1 trauma center. METHODS A 6-year retrospective cohort study utilizing our level 1 trauma center registry for patients transferred by GEMS or HEMS was performed. Demographics and outcome measures were compared. Raw and adjusted mortality was evaluated. Adjusted mortality was determined incorporating confounders, including patient demographics, comorbid conditions, mechanism of injury, injury severity score (ISS), Glasgow Coma Scale score, and EMS transport time. Chi-square, multivariable logistic regression, and independent sample T-test were utilized with significance, defined as P < .05. RESULTS Of 12 633 patients, 10 656 were transported via GEMS and 1977 with HEMS. Mean age was 55 for GEMS and 40 for HEMS (P < .001). Mean ISS was 9.29 and 11.73 for GEMS and HEMS (P < .001). Mean Revised Trauma Score was higher (less severe) for GEMS vs. HEMS (7.6 vs. 7.12, P < .001). Mean transport times for GEMS and HEMS was 39.45 vs. 47.29 minutes (P = .02). Raw mortality was 2.55% (307/10 656) for GEMS and 6.78% (134/1977) for HEMS. Adjusted mortality revealed a 16.6% increased mortality for GEMS compared to HEMS (adjusted odds ratio = 1.166, 95% CI: .815-1.668). CONCLUSIONS Air-lifted trauma patients were younger, more severely injured, and more hemodynamically unstable and required longer transport time but experienced lower adjusted mortality. Future research is needed to investigate whether reducing transport times and augmenting the advanced care already implemented by HEMS crews can improve outcomes.
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Affiliation(s)
- Adel Elkbuli
- Department of Surgery, Division of Trauma and Surgical Critical Care, 14506Kendall Regional Medical Center, Miami, FL, USA
| | - Brianna Dowd
- Department of Surgery, Division of Trauma and Surgical Critical Care, 14506Kendall Regional Medical Center, Miami, FL, USA
| | - Carol Sanchez
- Department of Surgery, Division of Trauma and Surgical Critical Care, 14506Kendall Regional Medical Center, Miami, FL, USA
| | - Saamia Shaikh
- Department of Surgery, Division of Trauma and Surgical Critical Care, 14506Kendall Regional Medical Center, Miami, FL, USA
| | - Mason Sutherland
- Department of Surgery, Division of Trauma and Surgical Critical Care, 14506Kendall Regional Medical Center, Miami, FL, USA
| | - Mark McKenney
- Department of Surgery, Division of Trauma and Surgical Critical Care, 14506Kendall Regional Medical Center, Miami, FL, USA.,Department of Surgery, University of South Florida, Tampa, FL, USA
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16
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Nacoti M, Fazzi F, Biroli F, Zangari R, Barbui T, Kochanek PM. Addressing Key Clinical Care and Clinical Research Needs in Severe Pediatric Traumatic Brain Injury: Perspectives From a Focused International Conference. Front Pediatr 2021; 8:594425. [PMID: 33537259 PMCID: PMC7849211 DOI: 10.3389/fped.2020.594425] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 11/06/2020] [Indexed: 12/28/2022] Open
Abstract
Traumatic brain injury (TBI) is a leading cause of morbidity and mortality in children and adolescents. Survivors of severe TBI are more prone to functional deficits, resulting in poorer school performance, poor health-related quality of life (HRQoL), and increased risk of mental health problems. Critical gaps in knowledge of pathophysiological differences between children and adults concerning TBI outcomes, the paucity of pediatric trials and prognostic models and the uncertain extrapolation of adult data to pediatrics pose significant challenges and demand global efforts. Here, we explore the clinical and research unmet needs focusing on severe pediatric TBI to identify best practices in pathways of care and optimize both inpatient and outpatient management of children following TBI.
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Affiliation(s)
- Mirco Nacoti
- Pediatric Intensive Care Unit, Department of Anesthesia and Intensive Care, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Francesco Fazzi
- Pediatric Intensive Care Unit, Department of Anesthesia and Intensive Care, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Francesco Biroli
- Fondazione per la Ricerca dell'Ospedale di Bergamo Research Foundation, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Rosalia Zangari
- Fondazione per la Ricerca dell'Ospedale di Bergamo Research Foundation, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Tiziano Barbui
- Fondazione per la Ricerca dell'Ospedale di Bergamo Research Foundation, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Patrick M. Kochanek
- Department of Critical Care Medicine, Safar Center for Resuscitation Research, John G Rangos Research Center, University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
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17
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Shinozaki RM, Schwingshackl A, Srivastava N, Grogan T, Kelly RB. Pediatric interfacility transport effects on mortality and length of stay. World J Pediatr 2021; 17:400-408. [PMID: 34319538 PMCID: PMC8363522 DOI: 10.1007/s12519-021-00445-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 07/13/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND We aimed to evaluate the effects of interfacility pediatric critical care transport response time, physician presence during transport, and mode of transport on mortality and length of stay (LOS) among pediatric patients. We hypothesized that a shorter response time and helicopter transports, but not physician presence, are associated with lower mortality and a shorter LOS. METHODS Retrospective, single-center, cohort study of 841 patients (< 19 years) transported to a quaternary pediatric intensive care unit and cardiovascular intensive care unit between 2014 and 2018 utilizing patient charts and transport records. Multivariate linear and logistic regression analyses adjusted for age, diagnosis, mode of transport, response time, stabilization time, return duration, mortality risk (pediatric index of mortality-2 and pediatric risk of mortality-3), and inotrope, vasopressor, or mechanical ventilation presence on admission. RESULTS Four hundred and twenty-eight (50.9%) patients were transported by helicopter, and 413 (49.1%) were transported by ambulance. Physicians accompanied 239 (28.4%) transports. The median response time was 2.0 (interquartile range 1.4-2.9) hours. Although physician presence increased the median response time by 0.26 hours (P = 0.020), neither physician presence nor response time significantly affected mortality, ICU length of stay (ILOS) or hospital length of stay (HLOS). Helicopter transports were not significantly associated with mortality or ILOS, but were associated with a longer HLOS (3.24 days, 95% confidence interval 0.59-5.90) than ambulance transports (P = 0.017). CONCLUSIONS These results suggest response time and physician presence do not significantly affect mortality or LOS. This may reflect the quality of pre-transport care and medical control communication. Helicopter transports were only associated with a longer HLOS. Our analysis provides a framework for examining transport workforce needs and associated costs.
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Affiliation(s)
- Rod M. Shinozaki
- grid.19006.3e0000 0000 9632 6718David Geffen School of Medicine at UCLA, Los Angeles, CA USA
| | - Andreas Schwingshackl
- grid.19006.3e0000 0000 9632 6718David Geffen School of Medicine at UCLA, Los Angeles, CA USA
| | - Neeraj Srivastava
- grid.19006.3e0000 0000 9632 6718David Geffen School of Medicine at UCLA, Los Angeles, CA USA
| | - Tristan Grogan
- grid.19006.3e0000 0000 9632 6718David Geffen School of Medicine at UCLA, Los Angeles, CA USA
| | - Robert B. Kelly
- grid.266093.80000 0001 0668 7243University of California, Irvine, Irvine, CA USA ,grid.414164.20000 0004 0442 4003Children’s Hospital of Orange County, 1201 West La Veta Avenue, Orange, CA 92868 USA
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18
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Paoli A, Pascolini M, Cipolotti G, Spagna A. Is Helicopter Really Faster Than Ambulance? The Padua Helicopter Emergency Medical Services Station Experience. Air Med J 2020; 39:399-403. [PMID: 33012480 DOI: 10.1016/j.amj.2020.05.012] [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: 05/06/2020] [Accepted: 05/21/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Helicopter transport plays a fundamental role in modern health systems, and, yet, it is not been the focus of scientific research, especially in Italy. Our objective was to analyze Padua helicopter emergency medical services (HEMS) station operations to discover whether this resource has been used correctly and advantageously. METHODS The study was conducted considering 115 helicopter air ambulance operations minutes in 2018. Additionally, using geographic information systems and estimated ambulance data, a comparison was drawn between air and ground emergency medical services. RESULTS Interfacility transports involved mainly adults. There were 65 (56.52%) "acute transports," 49 (42.61%) "back transports," and 1 "hyperspecialized care transport" (0.87%). The average route distance was 44.23 km; the modal class was 25 to 30 km. The average mission time was 1 hour 26 minutes; the modal class was 1 hour to 1 hour 15 minutes. The Pearson correlation coefficient between flying/traveling time and the route length was 0.92 for helicopter and 0.94 for ambulance, and between mission time and route length, it was 0.05 for helicopter and 0.94 for ambulance. CONCLUSION Helicopters are not always the fastest mode of transporting patients, and journey time is variable. Because of the importance of rapid response in emergency situations, we propose not to use helicopters for transports less than 50 km in distance.
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Affiliation(s)
- Andrea Paoli
- UOC Centrale Operativa Servizio di Urgenza ed Emergenza Medica 118, Azienda Ospedaliera di Padova, Padua, Italy
| | | | - Giovanni Cipolotti
- UOC Centrale Operativa Servizio di Urgenza ed Emergenza Medica 118, Azienda ULSS 1 Dolomiti, Pieve di Cadore, Italy
| | - Andrea Spagna
- UOC Centrale Operativa Servizio di Urgenza ed Emergenza Medica 118, Azienda Ospedaliera di Padova, Padua, Italy
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19
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Enomoto Y, Tsuchiya A, Tsutsumi Y, Ishigami K, Osone J, Togo M, Yasuda S, Inoue Y. Association between physician-staffed helicopter versus ground emergency medical services and mortality for pediatric trauma patients: A retrospective nationwide cohort study. PLoS One 2020; 15:e0237192. [PMID: 32785294 PMCID: PMC7423096 DOI: 10.1371/journal.pone.0237192] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 07/21/2020] [Indexed: 11/18/2022] Open
Abstract
Background Helicopter emergency medical services’ (HEMS) effectiveness for pediatric trauma patients remains unclear. We aimed to examine the relation between HEMS and reduced mortality in pediatric trauma patients. Methods This retrospective cohort study utilized data from the Japan Trauma Data Bank, a national multicenter clinical trauma database. Participants were aged <18 years, admitted between 2004 and 2015, and transported from the scene to the hospital by HEMS or ground emergency medical services (GEMS). We used a standardized mortality ratio (SMR) weight method, and fitted a marginal structural model to adjust for measured confounders. The SMR weight was calculated using the estimation of the propensity scores. A logistic regression model was used with the baseline independent variables to estimate the propensity score. Results Overall, 5,947 patients were identified in our study: 453 were transported by HEMS and 5,494 by GEMS. The mean injury severity score in the HEMS group was significantly higher than that in the GEMS group17.0 (Standard deviation = 11.0) vs 12.2 (Standard deviation = 9.2), p < .001. In-hospital mortality was higher in the HEMS group than that in the GEMS group in the unadjusted analysis (3.8% vs 1.3%, respectively; p < .001). After adjusting for covariates, HEMS transport was not associated with reduced hospital mortality. (odds ratio = 0.82, 95% confidence interval = 0.42–1.58). Conclusions HEMS was not associated with reduced mortality among pediatric trauma patients compared with GEMS in this nationwide study. Further investigation is necessary to determine who clearly benefits from HEMS as compared to GEMS.
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Affiliation(s)
- Yuki Enomoto
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
- Department of Emergency and Critical Care Medicine, National Hospital Organization Mito Medical Center, Ibaraki, Japan
- * E-mail:
| | - Asuka Tsuchiya
- Department of Emergency and Critical Care Medicine, National Hospital Organization Mito Medical Center, Ibaraki, Japan
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Yusuke Tsutsumi
- Department of Emergency and Critical Care Medicine, National Hospital Organization Mito Medical Center, Ibaraki, Japan
| | - Koji Ishigami
- Department of Emergency and Critical Care Medicine, National Hospital Organization Mito Medical Center, Ibaraki, Japan
| | - Junpei Osone
- Department of Emergency and Critical Care Medicine, National Hospital Organization Mito Medical Center, Ibaraki, Japan
| | - Masahito Togo
- Department of Emergency and Critical Care Medicine, National Hospital Organization Mito Medical Center, Ibaraki, Japan
| | - Susumu Yasuda
- Department of Emergency and Critical Care Medicine, National Hospital Organization Mito Medical Center, Ibaraki, Japan
| | - Yoshiaki Inoue
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
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20
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Helicopter transport in pediatric trauma: A new methodology using Need for Surgeon Presence to evaluate the necessity of air transport. Am J Surg 2020; 220:464-467. [DOI: 10.1016/j.amjsurg.2019.11.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 11/19/2019] [Accepted: 11/22/2019] [Indexed: 11/18/2022]
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21
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Grabowski RL, McNett M, Ackerman MH, Schubert C, Mion LC. Critical Care Helicopter Overtriage: A Failure Mode and Effects Analysis. Air Med J 2019; 38:408-420. [PMID: 31843152 DOI: 10.1016/j.amj.2019.07.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 07/15/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Overtriage (OT) of helicopter emergency medical services (HEMS) poses significant burden to multiple stakeholders. The project aims were to identify the following: 1) associated factors, 2) downstream effects, and 3) focus areas for change. METHODS We undertook a failure mode and effects analysis (FMEA) to evaluate our HEMS interfacility transport process. Data were collected from organizational finances and 3 key stakeholder groups: 1) interfacility patients transferred by HEMS in 2017 who were discharged from the receiving facility within 24 hours (n = 149), 2) flight registered nurses (n = 19), and 3) referring emergency medicine providers (EMPs) (n = 30) from the top HEMS users of 2017. The completed FMEA identified failure modes, the frequency and severity of effects, and unique risk profile numbers (RPNs). RESULTS Twelve failure modes were identified with 30 potential causes. Leading failure modes included inappropriate HEMS requests by EMPs (RPN = 343), inappropriate activation by EMS for interfacility transport (RPN = 343), and minimizing patient/family involvement in decision making (RPN = 315). Significant burdens to organizational finances and flight registered nurse satisfaction were identified. CONCLUSION Associated factors for interfacility HEMS OT, downstream effects, and areas for change were identified. EMP and emergency medical services practices, HEMS processes, and shared decision making may affect regional OT rates.
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Affiliation(s)
| | - Molly McNett
- Nursing Research and Evidence-Based Practice, MetroHealth Medical Center, Cleveland, Ohio
| | | | | | - Lorraine C Mion
- College of Nursing, The Ohio State University, Columbus, Ohio
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22
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Fedeles B, Galvagno SM. Helicopter Emergency Medical Services for Trauma: An Update. CURRENT SURGERY REPORTS 2019. [DOI: 10.1007/s40137-019-0239-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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23
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Moors XRJ, Van Lieshout EMM, Verhofstad MHJ, Stolker RJ, Den Hartog D. A Physician-Based Helicopter Emergency Medical Services Was Associated With an Additional 2.5 Lives Saved per 100 Dispatches of Severely Injured Pediatric Patients. Air Med J 2019; 38:289-293. [PMID: 31248540 DOI: 10.1016/j.amj.2019.04.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 02/18/2019] [Accepted: 04/24/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Physician-based helicopter emergency medical services (HEMS) provide specialist medical care to the accident scene in order to improve the survival of severely injured patients. Studies that focus on the role of physician-based HEMS in pediatric trauma are scarce. The aim of this retrospective, observational study was to determine the effect of physician-based HEMS assistance on the survival of severely injured pediatric patients. METHODS All consecutive severely injured pediatric patients (age < 18 years and Injury Severity Score > 15) treated between October 1, 2000, and February 28, 2013, were included. The survival of patients who received medical care of physician-based HEMS was compared with the survival of patients treated by an ambulance paramedic crew (ie, emergency medical services group) only. A regression model was developed for calculating the survival benefit in the physician-based HEMS group. RESULTS A total of 308 patients were included; 112 (36%) were primarily treated by emergency medical services, and 196 (64%) patients received additional physician-based HEMS assistance on scene. The model with the best diagnostic properties and fit contained physician-based HEMS assistance, 3 components of the Glasgow Coma Scale (eye, motor, and verbal) scored prehospitally (before intubation), ordinal values for the Injury Severity Scale, systolic blood pressure, and respiratory rate. This model predicted that 5 additional patients survived because of physician-based HEMS assistance. This corresponds with 2.5 additional lives saved per 100 physician-based HEMS dispatches for severely injured pediatric patients. CONCLUSION The data suggest that an additional 2.5 lives might be saved per 100 physician-based HEMS dispatches for severely injured pediatric patients.
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Affiliation(s)
- Xavier R J Moors
- Department of Anesthesiology, Erasmus MC, University Medical Center-Sophia Children's Hospital, Rotterdam, the Netherlands.
| | - Esther M M Van Lieshout
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Michael H J Verhofstad
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Robert Jan Stolker
- Department of Anesthesiology, Erasmus MC, University Medical Center-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Dennis Den Hartog
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
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24
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Starnes AB, Oluborode B, Knoles C, Burns B, McGinnis H, Stewart K. Direct Air Versus Ground Transport Predictors for Rural Pediatric Trauma. Air Med J 2018; 37:165-169. [PMID: 29735228 DOI: 10.1016/j.amj.2018.01.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 01/30/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Traumatic injury is the leading cause of mortality in children and the most common cause of emergency medical services transport in pediatric populations. We aimed to identify what factors are currently associated with selection for helicopter transport (HEMS) over ground ambulance (GEMS) in a primarily rural state. METHODS We performed a retrospective case-control study of trauma patients younger than 18 years old reported to the Oklahoma State Trauma Registry between 2005 and 2014 who received direct transport from the scene of injury to a tertiary trauma center within the state. Factors associated with HEMS transport over GEMS were identified by multivariate regression analysis. RESULTS Of the 1,700 patients in the study group, 50.8% were transported by HEMS. Increased distance (odds ratio [OR] = 6.1-18.6), lower Glasgow Coma Scale (OR = 2.5), multisystem injury (OR = 1.5), intubation (OR = 2.7), motor vehicle collision-related injuries (OR = 2.1), and elevated heart rate (OR = 1.8) were all associated with increased odds of HEMS transport, with distance being the strongest factor. CONCLUSION This study found that the principal determinants of triage to HEMS transport in the case of pediatric trauma in a rural state were primarily distance to a major trauma center and clinical factors relating to the type and severity of injury.
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Affiliation(s)
| | | | - Curtis Knoles
- University of Oklahoma School of Community Medicine, Tulsa, OK
| | - Boyd Burns
- University of Oklahoma School of Community Medicine, Tulsa, OK
| | | | - Kenneth Stewart
- University of Oklahoma School of Community Medicine, Tulsa, OK
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Thomas SH, Blumen I. Helicopter Emergency Medical Services Literature 2014 to 2016: Lessons and Perspectives, Part 2-Nontrauma Transports and General Issues. Air Med J 2018; 37:126-130. [PMID: 29478578 DOI: 10.1016/j.amj.2017.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 10/30/2017] [Indexed: 06/08/2023]
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Thomas SH, Blumen I. Helicopter Emergency Medical Services Literature 2014 to 2016: Lessons and Perspectives, Part 1-Helicopter Transport for Trauma. Air Med J 2018; 37:54-63. [PMID: 29332779 DOI: 10.1016/j.amj.2017.10.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 10/30/2017] [Indexed: 11/30/2022]
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