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Lapidus O, Rubenson Wahlin R, Bäckström D. Trauma patient transport to hospital using helicopter emergency medical services or road ambulance in Sweden: a comparison of survival and prehospital time intervals. Scand J Trauma Resusc Emerg Med 2023; 31:101. [PMID: 38104083 PMCID: PMC10725597 DOI: 10.1186/s13049-023-01168-9] [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: 09/05/2023] [Accepted: 12/08/2023] [Indexed: 12/19/2023] Open
Abstract
BACKGROUND The benefits of helicopter emergency medical services (HEMS) transport of adults following major trauma have been examined with mixed results, with some studies reporting a survival benefit compared to regular emergency medical services (EMS). The benefit of HEMS in the context of the Swedish trauma system remains unclear. AIM To investigate differences in survival and prehospital time intervals for trauma patients in Sweden transported by HEMS compared to road ambulance EMS. METHODS A total of 74,032 trauma patients treated during 2012-2022 were identified through the Swedish Trauma Registry (SweTrau). The primary outcome was 30-day mortality and Glasgow Outcome Score at discharge from hospital (to home or rehab); secondary outcomes were the proportion of severely injured patients who triggered a trauma team activation (TTA) on arrival to hospital and the proportion of severely injured patients with GCS ≤ 8 who were subject to prehospital endotracheal intubation. RESULTS 4529 out of 74,032 patients were transported by HEMS during the study period. HEMS patients had significantly lower mortality compared to patients transported by EMS at 1.9% vs 4.3% (ISS 9-15), 5.4% vs 9.4% (ISS 16-24) and 31% vs 42% (ISS ≥ 25) (p < 0.001). Transport by HEMS was also associated with worse neurological outcome at discharge from hospital, as well as a higher rate of in-hospital TTA for severely injured patients and higher rate of prehospital intubation for severely injured patients with GCS ≤ 8. Prehospital time intervals were significantly longer for HEMS patients compared to EMS across all injury severity groups. CONCLUSION Trauma patients transported to hospital by HEMS had significantly lower mortality compared to those transported by EMS, despite longer prehospital time intervals and greater injury severity. However, this survival benefit may have been at the expense of a higher degree of adverse neurological outcome. Increasing the availability of HEMS to include all regions should be considered as it may be the preferrable option for transport of severely injured trauma patients in Sweden.
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Affiliation(s)
- Oscar Lapidus
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
| | - Rebecka Rubenson Wahlin
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Perioperative Medicine and Intensive Care, Karolinska University Hospital, Huddinge, Sweden
- Ambulance Medical Service in Stockholm (AISAB), Stockholm, Sweden
| | - Denise Bäckström
- Division of Surgery, Orthopedics and Oncology, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- VO Ambulans Och Akut, Region Gävleborg, Sweden
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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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Salhi RA, Iyengar S, da Silva Bhatia B, Smith GC, Heisler M. How do current police practices impact trauma care in the prehospital setting? A scoping review. J Am Coll Emerg Physicians Open 2023; 4:e12974. [PMID: 37229183 PMCID: PMC10204184 DOI: 10.1002/emp2.12974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 04/08/2023] [Accepted: 04/27/2023] [Indexed: 05/27/2023] Open
Abstract
Objective In the United States, police are often important co-responders to 911 calls with emergency medical services for medical emergencies. To date, there remains a lack of a comprehensive understanding of the mechanisms by which police response modifies time to in-hospital medical care for traumatically injured patients. Further, it remains unclear if differentials exist within or between communities. A scoping review was performed to identify studies evaluating prehospital transport of traumatically injured patients and the role or impact of police involvement. Methods PubMed, SCOPUS, and Criminal Justice Abstracts databases were utilized to identify articles. English-language, US-based, peer-reviewed articles published on or prior to March 30, 2022 were eligible for inclusion. Results Of 19,437 articles initially identified, 70 articles were selected for full review and 17 for final inclusion. Key findings included (1) current law enforcement practices involving scene clearance introduce the potential for delayed patient transport but to date there is little research quantifying delays; (2) police transport protocols may decrease transport times; and (3) there are no studies examining the potential impact of scene clearance practices at the patient or community level. Conclusions Our results highlight that police are often the first on scene when responding to traumatic injuries and have an active role via scene clearance or, in some systems, patient transport. Despite the significant potential for impact on patient well-being, there remains a paucity of data examining and driving current practices.
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Affiliation(s)
- Rama A. Salhi
- Department of Emergency MedicineMassachusetts General HospitalBostonMassachusettsUSA
| | - Sonia Iyengar
- University of Michigan Medical SchoolAnn ArborMichiganUSA
| | | | - Graham C. Smith
- Department of Emergency MedicineUniversity of MichiganAnn ArborMichiganUSA
- Washtenaw/Livingston Medical Control AuthorityAnn ArborMichiganUSA
| | - Michele Heisler
- Department of Internal MedicineUniversity of MichiganAnn ArborMichiganUSA
- Institute for Healthcare Policy and InnovationUniversity of MichiganAnn ArborMichiganUSA
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Richards JB, Frakes MA, Grant C, Cohen JE, Wilcox SR. Air Versus Ground Transport Times in an Urban Center. PREHOSP EMERG CARE 2023; 27:59-66. [PMID: 34788200 DOI: 10.1080/10903127.2021.2005194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
PURPOSE Given that the benefits of helicopter transport vary with geography and healthcare systems, we assessed transport times for rotor wing versus ground transport over a 10 year period in an urban setting. MATERIALS AND METHODS All completed transports from 153 sending hospitals in New England from 2009 through 2018 to 8 local tertiary care centers were extracted from an administrative database. The primary outcome of interest was patient-loaded transport time for rotor wing versus ground transports. Overall, 25,483 patient transports met the inclusion criteria and were included in this study. We assessed patient-loaded transport time for all transports, and determined mean time to arrive at the scene, scene to patient time, the bedside time, and distance at which the patient-loaded transport time was faster for rotor wing than for ground transport. We also performed subgroup analyses, evaluating transport times by time of day, day of the week, and destination. RESULTS The most common indication for transport was adult trauma, (n = 6,008, 23.6%) followed by adult cardiac (n = 4359, 17.1%), adult neuro (3729 14.6%), and adult medical (n = 3691, 14.5%). The median miles traveled for all transports was 26.0, IQR 14-38, ranging from 1 to 264 miles. The median patient-loaded transport time was 27 min (IQR 15-40) for all transports. Nearly all time intervals were shorter for rotor wing versus ground transports, and patient-loaded transport time was significantly shorter at 15 minutes compared to 38 minutes (IQR 12-22 vs 28-33, p < 0.001). There was no distance at which the patient-loaded transport time was faster for ground transport than for rotor wing. CONCLUSIONS In over 25,000 transports over 10 years, in a compact metropolitan area with relatively short transport distances and times, the use of the helicopter was associated with substantial time savings.
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Affiliation(s)
- Jeremy B Richards
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts.,Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | | | | | - Jason E Cohen
- Boston MedFlight, Bedford, Massachusetts.,Division of Critical Care Medicine, Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts.,Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Susan Renee Wilcox
- Boston MedFlight, Bedford, Massachusetts.,Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts.,Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts.,Division of Critical Care Medicine, Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts
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Strony R, Slimmer K, Slimmer S, Corros P, Davis R, Zhu B, Niedzwiecki K, Cho D, Lapczynski J, Jia S, Lopez R, Schoenwetter D. Helicopter Emergency Medical Services Performed Extended Focused Assessment With Sonography: Training, Workflow, and Sustainable Quality. Air Med J 2022; 41:209-216. [PMID: 35307145 DOI: 10.1016/j.amj.2021.11.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/18/2021] [Accepted: 11/21/2021] [Indexed: 06/14/2023]
Abstract
The extended focused assessment of trauma (EFAST) examination is an invaluable tool for the initial evaluation of the trauma patient. Miniaturization of ultrasound has enabled helicopter emergency medical services (HEMS) to use point-of-care ultrasound to care for trauma patients on scene. Our study demonstrated that HEMS crews accurately performed EFAST examinations after the implementation of a novel HEMS EFAST workflow, multifaceted training, and ongoing quality assurance. The HEMS crews' overall sensitivity was 53%, and specificity was 98%. The obtained image quality was highest for the lung, cardiac, and right upper quadrant components of the EFAST. Our results suggest that with a structured multifaceted training program, user-friendly workflow, and ongoing quality assurance, HEMS crews can perform EFAST examinations safely and reliably in the field. This would allow HEMS crews to detect life-threatening, time-sensitive conditions such as a pneumothorax, pericardial effusion, and intraperitoneal hemorrhage. HEMS EFAST has the potential to triage certain trauma patients directly to the operating room or newly emerging hybrid suites, bypassing the emergency room and saving crucial time.
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Affiliation(s)
- Robert Strony
- Department of Emergency Medicine, Geisinger Medical Center, Danville, PA.
| | | | - Samuel Slimmer
- Department of Emergency Medicine, Geisinger Medical Center, Danville, PA
| | - Pete Corros
- Geisinger Medical Center, Life Flight, Danville, PA
| | - Richard Davis
- Department of Emergency Medicine, Geisinger Medical Center, Danville, PA
| | - Bo Zhu
- Department of Emergency Medicine, Geisinger Wyoming Valley, Wilkes Barre, PA
| | | | - Davis Cho
- Philadelphia College of Osteopathic Medicine, Philadelphia, PA
| | - John Lapczynski
- Department of Emergency Medicine, Anne Arundel Medical Center, Baltimore, MD
| | - Sharon Jia
- Department of Emergency Medicine, Geisinger Medical Center, Danville, PA
| | - Richard Lopez
- Geisinger Wyoming Valley, Department of Trauma Surgery, Willkes Barre, PA
| | - David Schoenwetter
- Department of Emergency Medicine, Geisinger Wyoming Valley, Wilkes Barre, PA
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