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Schoenfeld D, Thomas CE, McCartin MP, Blumen IJ, Galvagno SM, Thomas SH. Natural Experiment Outcomes Studies in Rotor Wing Air Medical Transport: Systematic Review and Meta-Analysis of Before-and-After and Helicopter-Unavailable Publications From 1970 to 2022. Air Med J 2024; 43:124-132. [PMID: 38490775 DOI: 10.1016/j.amj.2023.11.005] [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: 10/02/2023] [Accepted: 11/12/2023] [Indexed: 03/17/2024]
Abstract
OBJECTIVE Helicopter emergency medical services (HEMS) is widely used for prehospital and interfacility transport, but there is a paucity of HEMS outcomes data from studies using randomized controlled trial designs. In the absence of robust randomized controlled trial evidence, judgments regarding HEMS potential benefit must be informed by observational data. Within the study design set of observational analyses, the natural experiment (NE) is notable for its high potential methodologic quality; NE designs are occasionally denoted "quasi-experimental." The aim of this study is to examine all NE outcomes studies in the HEMS literature and to discern what lessons can be learned from these potentially high-quality observational data. METHODS HEMS NE studies were identified during the development of a new HEMS Outcomes Assessment Research Database (HOARD). HOARD was constructed using a broad-ranging search of published and gray literature resources (eg, PubMed, Embase, and Google Scholar) that used variations of the terms "helicopter EMS," "air ambulance," and "air medical transport." Among the 221 studies ultimately included in HOARD, 16 NE publications describing 13 sets of observational data comprising myriad diagnostic groups were identified. Of these 16 HEMS NEs, 4 HEMS NE studies assessing trauma outcomes were used in a meta-analysis. A meta-analysis was also performed of 4 HEMS NE studies. RESULTS Although the disparity of studies (in terms of both case mix and end points) precluded the generation of a pooled effect estimate of an adjusted mortality benefit of HEMs versus ground emergency medical services, HEMS was found to be associated with outcomes improvement in 8 of the 13 cohorts. CONCLUSION The weight of the NE evidence supports a conclusion of some form of HEMS-mediated outcomes improvement in a variety of patient types. Meta-analysis of 4 HEMS NE studies assessing trauma outcomes generated a model with acceptable heterogeneity (I2 = 43%, Q test: P = .16), which significantly (P < .01) favored HEMS use with a pooled HEMS survival odd ratio estimate of 1.66 (95% confidence interval, 1.23-2.22).
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Affiliation(s)
- David Schoenfeld
- EMS Division, Department of Emergency Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
| | - Caroline E Thomas
- EMS Division, Department of Emergency Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
| | - Michael P McCartin
- Department of Medicine, Section of Emergency Medicine, University of Chicago, Chicago, IL.
| | - Ira J Blumen
- Department of Medicine, Section of Emergency Medicine, University of Chicago, Chicago, IL
| | - Samuel M Galvagno
- Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, MD
| | - Stephen H Thomas
- EMS Division, Department of Emergency Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA; EMS Division, Department of Emergency Medicine, Harvard Medical School, Boston, MA; Barts & The London School of Medicine, Queen Mary University of London, London, UK
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Myklevoll KR, Zakariassen E, Morken T, Baste V, Blinkenberg J, Bondevik GT. Primary care doctors in acute call-outs to severe trauma incidents in Norway - associations with factors related to patients and doctors. Scand J Prim Health Care 2023; 41:196-203. [PMID: 37256689 PMCID: PMC10478583 DOI: 10.1080/02813432.2023.2216235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 05/16/2023] [Indexed: 06/02/2023] Open
Abstract
OBJECTIVE Severe trauma patients need immediate prehospital intervention and transfer to a specialised trauma hospital. In Norway, primary care doctors (PCDs) are an integrated part of the prehospital trauma care. The aim of this study was to investigate the degree to which PCDs were involved in prehospital care of severe trauma patients and how factors related to patients and doctors were associated with call-outs to these incidents. DESIGN This was a registry-based study in Norway on severe trauma patients with acute hospital admission during the period 2012-2018. SETTING Data was obtained from three Norwegian official registries. SUBJECTS By linking the registries, we studied the actions taken by the PCDs, whether they called out to severe trauma incidents. MAIN OUTCOME MEASURES In multivariable regression models, we investigated whether factors related to the PCDs (age, sex, specialisation in general practice (GP)) and patients (age, sex, duration of hospital stay, type of injury) were associated with call-outs. RESULTS Out of 4342 severe trauma incidents, PCDs had documented involvement in 1683 (39%) and called out to 644 (15%). Increased proportions of PCD call-outs to severe trauma incidents were significantly associated with lower age of PCD, being a GP specialist, lower patient age, being a male patient, increased length of hospital stay and injuries to the head and the neck. CONCLUSIONS PCDs called out to a relatively low proportion of severe trauma patients. Several factors related to patients and doctors were associated with call-outs to severe trauma incidents in Norway.
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Affiliation(s)
- Kristian Rikstad Myklevoll
- Section for General Practice, Department of Global Public Health and Primary Care, University of Bergen, Norway
- National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Bergen, Norway
| | - Erik Zakariassen
- Section for General Practice, Department of Global Public Health and Primary Care, University of Bergen, Norway
- National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Bergen, Norway
| | - Tone Morken
- National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Bergen, Norway
| | - Valborg Baste
- National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Bergen, Norway
| | - Jesper Blinkenberg
- National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Bergen, Norway
| | - Gunnar Tschudi Bondevik
- Section for General Practice, Department of Global Public Health and Primary Care, University of Bergen, Norway
- National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Bergen, Norway
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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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Pedersen HB, Pedersen BB, Biilmann M, Møller M, Lohse N, Vedsted P, Mikkelsen S. Medical evacuations in Greenland in 2018: a descriptive study. Int J Circumpolar Health 2022; 81:2014634. [PMID: 34939902 PMCID: PMC8725698 DOI: 10.1080/22423982.2021.2014634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 12/01/2021] [Accepted: 12/01/2021] [Indexed: 12/05/2022] Open
Abstract
Information regarding medical evacuations in Greenland is sparse. This study provides an overview of incidence, costs, and diagnoses leading to medical evacuations in Greenland in 2018. This is a retrospective, observational study. Patients with a valid Danish civil personal registration number were included. Data were obtained by scrutinising the itinerary of the Greenland travel coordination office and the medical records. 481 patients were identified. Forty-nine patients were excluded. 432 patients were analysed. Two-thirds of the evacuations were carried out within Greenland. The overall incidence of evacuations was 7.7 evacuations per 1,000 inhabitants per year. This differed, however, between the five different health regions. The cost of a medical evacuation ranged from less than 4,800 US dollars to more than 50,000 US dollars per case. Pregnancy and childbirth accounted for the majority of evacuations in women (31.2%) while diseases within the circulatory system and digestive tract accounted for the majority of evacuations in men (39.8%). The costs of medical evacuations may be reduced when combining evacuations of more than one patient. This indicates that combining evacuations of multiple patients from one health region by applying mandatory use of a central coordinating service may be beneficial.
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Affiliation(s)
- Helena Breum Pedersen
- The Prehospital Research Unit, Region of Southern Denmark, Odense University Hospital, Odense, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Bastian Breum Pedersen
- The Prehospital Research Unit, Region of Southern Denmark, Odense University Hospital, Odense, Denmark
| | - Mark Biilmann
- The Prehospital Research Unit, Region of Southern Denmark, Odense University Hospital, Odense, Denmark
| | - Malik Møller
- Department of Emergency Medicine, Holbæk Hospital, Holbæk, Denmark
| | - Nicolai Lohse
- Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
- Department of Emergency Medicine, Copenhagen University Hospital Nordsjælland, Hillerød, Denmark
| | - Peter Vedsted
- Ilulissat Hospital, Ilulissat, Greenland
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Søren Mikkelsen
- The Prehospital Research Unit, Region of Southern Denmark, Odense University Hospital, Odense, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
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Møller TP, Ersbøll AK, Kjærulff TM, Bihrmann K, Alstrup K, Knudsen L, Hansen TM, Berlac PA, Lippert F, Barfod C. Helicopter emergency medical services missions to islands and the mainland during a 3-year period in Denmark: a population-based study on patient and sociodemographic characteristics, comorbidity, and use of healthcare services. Scand J Trauma Resusc Emerg Med 2021; 29:152. [PMID: 34663396 PMCID: PMC8522108 DOI: 10.1186/s13049-021-00963-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 09/30/2021] [Indexed: 11/12/2022] Open
Abstract
Background The Danish Helicopter Emergency Medical Services (HEMS) is part of the Danish Emergency Medical Services System serving 5.7 million citizens with 1% living on islands not connected to the mainland by road. HEMS is dispatched based on pre-defined criteria including severity and urgency, and moreover to islands for less urgent cases, when rapid transport to further care is needed. The study aim was to characterize patient and sociodemographic factors, comorbidity and use of healthcare services for patients with HEMS missions to islands versus mainland. Methods Descriptive study of data from the HEMS database in a three-year period from 1 October 2014 to 30 September 2017. All missions in which a patient was either treated on scene or transported by HEMS were included. Results Of 5776 included HEMS missions, 1023 (17.7%) were island missions. In total, 90.2% of island missions resulted in patient transport by HEMS compared with 62.1% of missions to the mainland. Disease severity was serious or life-threatening in 34.7% of missions to islands compared with 65.1% of missions to mainland and less interventions were performed by HEMS on island missions. The disease pattern differed with more “Other diseases” registered on islands compared with the mainland where cardiovascular diseases and trauma were the leading causes of contact. Patients from islands were older than patients from the mainland. Sociodemographic characteristics varied between inhabiting island patients and mainland patients: more island patients lived alone, less were employed, more were retired, and more had low income. In addition, residing island patients had to a higher extend severe comorbidity and more contacts to general practitioners and hospitals compared with the mainland patients. Conclusions HEMS missions to islands count for 17.7% of HEMS missions and 90.2% of island missions result in patient transport. The island patients encountered by HEMS are less severely diseased or injured and interventions are less frequently performed. Residing island patients are older than mainland patients and have lower socioeconomic position, more comorbidities and a higher use of health care services. Whether these socio-economic differences result in longer hospital stay or higher mortality is still to be investigated. Supplementary Information The online version contains supplementary material available at 10.1186/s13049-021-00963-6.
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Affiliation(s)
- Thea Palsgaard Møller
- Copenhagen Emergency Medical Services and University of Copenhagen, Copenhagen, Denmark.
| | - Annette Kjær Ersbøll
- National Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | | | - Kristine Bihrmann
- National Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Karen Alstrup
- Department of Research and Development, Pre-Hospital Emergency Medical Services, Central Denmark Region, Aarhus, Denmark
| | - Lars Knudsen
- Department of Anesthesiology, Aarhus University Hospital, Aarhus, Denmark.,The Danish Air Ambulance, Aarhus, Denmark
| | | | - Peter Anthony Berlac
- Copenhagen Emergency Medical Services and University of Copenhagen, Copenhagen, Denmark
| | - Freddy Lippert
- Copenhagen Emergency Medical Services and University of Copenhagen, Copenhagen, Denmark
| | - Charlotte Barfod
- Copenhagen Emergency Medical Services and University of Copenhagen, Copenhagen, Denmark
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6
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Hoshiyama E, Noguchi T, Wake K, Zaitsu M, Hishinuma H, Sunaga J, Haruyama Y, Takahashi K, Kobashi G, Ono K. Characteristics of Emergency Neurological Patients Who Were Transported by Helicopter Emergency Medical Services in Tochigi, Japan. TOHOKU J EXP MED 2021; 255:79-89. [PMID: 34588376 DOI: 10.1620/tjem.255.79] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In Japan, reports on the association of individual characteristics, and geographical distance and time with clinical outcomes for neurological emergencies involving helicopter emergency medical services (HEMS) are scarce. Using Tochigi HEMS data (2010-2018), we assessed the characteristics of 1,170 emergency neurological patients (e.g., stroke, neurotrauma, and seizure) at the base hospital, which covered 58% of all HEMS patients in the prefecture. After initial treatment in the emergency room, emergency physicians confirmed the clinical outcomes of each patient compared to those at the incident sites (recovery/non-recovery). We calculated the geographic distance from the base hospital to each incident site, and estimated and adjusted odds ratios (aOR) and 95% confidence intervals (CI) for non-recovery against distance. The mean distance between the incident site and base hospital was 22.0 ± 11.7 km, and 77.4% of patients recovered following initial treatment. Two peak age groups were observed among emergency neurological diseases, including seizures in patients who were aged < 5 years and stroke and neurotrauma in patients who were aged 70-80 years. The percentages of stroke, traumatic head and brain injury, and seizure were 35.8%, 29.2%, and 22.8%, respectively. The incidence of stroke (aOR = 11.8, 95% CI 6.86-20.3) and neurotrauma (aOR = 4.86, 95% CI 2.78-8.51) independently predicted a poor prognosis. However, no significant association was observed with the distance from the base hospital. Therefore, in the Tochigi prefecture, geographical disparities may not affect the short-term prognosis of patients with neurological emergencies who were transported by HEMS.
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Affiliation(s)
- Eisei Hoshiyama
- Department of Emergency and Critical Care Medicine, Dokkyo Medical University School of Medicine
| | - Takafumi Noguchi
- Department of Public Health, Dokkyo Medical University School of Medicine.,Department of Adult Nursing, Dokkyo Medical University School of Nursing
| | - Koji Wake
- Department of Emergency and Critical Care Medicine, Dokkyo Medical University School of Medicine
| | - Masayoshi Zaitsu
- Department of Public Health, Dokkyo Medical University School of Medicine
| | - Hidekazu Hishinuma
- Department of Public Health, Dokkyo Medical University School of Medicine.,Department of Adult Nursing, Dokkyo Medical University School of Nursing
| | - Junri Sunaga
- Department of Emergency and Critical Care Medicine, Dokkyo Medical University School of Medicine.,Department of Public Health, Dokkyo Medical University School of Medicine
| | - Yasuo Haruyama
- Integrated Research Faculty for Advanced Medical Sciences, Dokkyo Medical University School of Medicine
| | - Kyo Takahashi
- Department of Public Health, Dokkyo Medical University School of Medicine
| | - Gen Kobashi
- Department of Public Health, Dokkyo Medical University School of Medicine
| | - Kazuyuki Ono
- Department of Emergency and Critical Care Medicine, Dokkyo Medical University School of Medicine
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Deeb AP, Phelos HM, Peitzman AB, Billiar TR, Sperry JL, Brown JB. Geospatial assessment of helicopter emergency medical service overtriage. J Trauma Acute Care Surg 2021; 91:178-185. [PMID: 33605701 PMCID: PMC8243854 DOI: 10.1097/ta.0000000000003122] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Despite evidence of benefit after injury, helicopter emergency medical services (HEMS) overtriage remains high. Scene and transfer overtriage are distinct processes. Our objectives were to identify geographic variation in overtriage and patient-level predictors, and determine if overtriage impacts population-level outcomes. METHODS Patients 16 years or older undergoing scene or interfacility HEMS in the Pennsylvania Trauma Outcomes Study were included. Overtriage was defined as discharge within 24 hours of arrival. Patients were mapped to zip code, and rates of overtriage were calculated. Hot spot analysis identified regions of high and low overtriage. Mixed-effects logistic regression determined patient predictors of overtriage. High and low overtriage regions were compared for population-level injury fatality rates. Analyses were performed for scene and transfer patients separately. RESULTS A total of 85,572 patients were included (37.4% transfers). Overtriage was 5.5% among scene and 11.8% among transfer HEMS (p < 0.01). Hot spot analysis demonstrated geographic variation in high and low overtriage for scene and transfer patients. For scene patients, overtriage was associated with distance (odds ratio [OR], 1.03; 95% confidence interval [CI], 1.01-1.06 per 10 miles; p = 0.04), neck injury (OR, 1.27; 95% CI, 1.01-1.60; p = 0.04), and single-system injury (OR, 1.37; 95% CI, 1.15-1.64; p < 0.01). For transfer patients, overtriage was associated with rurality (OR, 1.64; 95% CI, 1.22-2.21; p < 0.01), facial injury (OR, 1.22; 95% CI, 1.03-1.44; p = 0.02), and single-system injury (OR, 1.35; 95% CI, 1.18-2.19; p < 0.01). For scene patients, high overtriage was associated with higher injury fatality rate (coefficient, 1.72; 95% CI, 1.68-1.76; p < 0.01); low overtriage was associated with lower injury fatality rate (coefficient, -0.73; 95% CI, -0.78 to -0.68; p < 0.01). For transfer patients, high overtriage was not associated with injury fatality rate (p = 0.53); low overtriage was associated with lower injury fatality rate (coefficient, -2.87; 95% CI, -4.59 to -1.16; p < 0.01). CONCLUSION Geographic overtriage rates vary significantly for scene and transfer HEMS, and are associated with population-level outcomes. These findings can help guide targeted performance improvement initiatives to reduce HEMS overtriage. LEVEL OF EVIDENCE Therapeutic, level IV.
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Affiliation(s)
- Andrew-Paul Deeb
- Division of Trauma and General Surgery, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213
| | - Heather M. Phelos
- Division of Trauma and General Surgery, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213
| | - Andrew B. Peitzman
- Division of Trauma and General Surgery, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213
| | - Timothy R. Billiar
- Division of Trauma and General Surgery, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213
| | - Jason L. Sperry
- Division of Trauma and General Surgery, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213
| | - Joshua B. Brown
- Division of Trauma and General Surgery, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213
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Alstrup K, Rognås L, Sollid S, Johnsen SP, Valentin JB, Petersen JAK. Association of Helicopter vs Ground Emergency Medical Transportation With 1-Year Mortality in Denmark. JAMA Netw Open 2021; 4:e2033318. [PMID: 33427886 PMCID: PMC7801934 DOI: 10.1001/jamanetworkopen.2020.33318] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
IMPORTANCE Appropriate use of helicopter emergency medical service (HEMS) is important in ensuring that patients with critical illness or injury receive adequate treatment. OBJECTIVE To investigate the association between use of HEMS compared with use of ground EMS (GEMS) and mortality overall and in a subgroup of patients with critical illness or injury. DESIGN, SETTING, AND PARTICIPANTS This register-based, nationwide cohort study used data retrieved from Danish registries from October 1, 2014, to April 30, 2018. Patients receiving GEMS originated from dispatched HEMS missions for which a helicopter was unavailable. For the primary analysis, patients from accepted HEMS missions and patients from missions in which HEMS was dispatched but unavailable were included. The secondary analysis included patients assigned a hospital International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) diagnosis considered a critical illness or injury. These patients were selected via a consensus-based agreement among all authors by reviewing the Danish version of the World Health Organization's ICD-10 classification. Data were analyzed from March to June 2020. EXPOSURES Dispatch of HEMS vs GEMS unit (primary analysis) and treatment and transport by HEMS vs GEMS unit among patients with critical illness or injury (secondary analysis). MAIN OUTCOMES AND MEASURES One-year mortality was retrieved from the Danish Civil Registration System. RESULTS Among 10 618 patients (median [interquartile range] age, 60 [42-72] years; 6834 [64.4%] men) included in the primary analysis, 9480 patients (89.3%) received HEMS and 1138 patients (10.7%) received GEMS. Median (interquartile range) age was 60 (42-72) years, and 6834 patients (64.4%) were men. Adjusted cumulative 1-year mortality was 23.2% (95% CI, 22.4%-24.1%) among patients receiving HEMS vs 24.5% (95% CI, 21.9%-27.1%) among patients receiving GEMS. The difference in mortality risk for HEMS compared with GEMS was not statistically significant (hazard ratio, 0.94 [95% CI, 0.84-1.06]). Among 2260 patients with critical illness or injury receiving HEMS, compared with 315 patients with critical illness or injury receiving GEMS, adjusted cumulative 1-year mortality was 25.1% (95% CI, 23.5%-26.7%) vs 27.1% (95% CI, 22.0%-32.1%). The difference in mortality risk for HEMs compared with GEMs was not statistically significant (hazard ratio, 0.91 [95% CI, 0.73-1.14]). CONCLUSIONS AND RELEVANCE This study found that 1 year after dispatch, the use of HEMS, compared with the use of GEMS, was not associated with a statistically significant difference in mortality overall or mortality among patients with critical illness or injury. Further research is needed to determine whether optimized dispatch systems may be associated with further improvements in survival among selected patients.
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Affiliation(s)
- Karen Alstrup
- Department of Research and Development, Prehospital Emergency Medical Services, Central Denmark Region, Aarhus, Denmark
| | - Leif Rognås
- Department of Research and Development, Prehospital Emergency Medical Services, Central Denmark Region, Aarhus, Denmark
- Department of Anaesthesiology, Aarhus University Hospital, Aarhus, Denmark
- Danish Air Ambulance, Denmark
| | - Stephen Sollid
- Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
- Norwegian Air Ambulance Foundation, Oslo, Norway
| | - Søren Paaske Johnsen
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University and Aalborg University Hospital, Aalborg, Denmark
| | - Jan Brink Valentin
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University and Aalborg University Hospital, Aalborg, Denmark
| | - Jens Aage Kølsen Petersen
- Department of Anaesthesiology, Aarhus University Hospital, Aarhus, Denmark
- Danish Air Ambulance, Denmark
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9
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Mohindru J, Griggs JE, de Coverly R, Lyon RM, Ter Avest E. Dispatch of a helicopter emergency medicine service to patients with a sudden, unexplained loss of consciousness of medical origin. BMC Emerg Med 2020; 20:92. [PMID: 33238877 PMCID: PMC7690130 DOI: 10.1186/s12873-020-00388-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 11/19/2020] [Indexed: 11/25/2022] Open
Abstract
Background Sudden loss of consciousness (LOC) in the prehospital setting in the absence of cardiac arrest and seizure activity may be a challenge from a dispatcher’s perspective: The aetiology is varied, with many causes being transient and mostly self-limiting, whereas other causes are potentially life threatening. In this study we aim to evaluate the dispatch of HEMS to patients with LOC of medical origin, by exploring to which patients with a LOC HEMS is dispatched, which interventions HEMS teams perform in these patients, and whether HEMS interventions can be predicted by patient characteristics. Methods We performed retrospective cohort study of all patients with a reported unexplained LOC (e.g. not attributable to a circulatory arrest or seizures) attended by the Air Ambulance Kent, Surrey & Sussex (AAKSS), over a 4-year period (July 2013–December 2017). Primary outcome was defined as the number of HEMS-specific interventions performed in patients with unexplained LOC. Secondary outcome was the relation of clinical- and dispatch criteria with HEMS interventions being performed. Results During the study period, 127 patients with unexplained LOC were attended by HEMS. HEMS was dispatched directly to 25.2% of the patients, but mostly (74.8%) on request of the ground ambulance crews. HEMS interventions were performed in 65% of the patients (Prehospital Emergency Anaesthesia 56%, hyperosmolar therapy 21%, antibiotic/antiviral therapy 8%, vasopressor therapy 6%) and HEMS conveyed most patients (77%) to hospital. Acute neurological pathology was a prevalent underlying cause of unexplained LOC: 38% had gross pathology on their CT-scan upon arrival in hospital. Both GCS (r = − 0.60, p < .001) and SBP (r = 0.31, p < .001) were related to HEMS interventions being performed on scene. A GCS < 13 predicted the need for HEMS interventions in our population with a sensitivity of 94.9% and a specificity 75% (AUC 0.85). Conclusion HEMS dispatchers and ambulance personnel are able to identify a cohort of patients with unexplained LOC of medical origin who suffer from potentially life threatening (mainly neurological) pathology, in whom HEMS specific intervention are frequently required. Presenting GCS can be used to inform the triage process of patients with LOC at an early stage. Supplementary Information The online version contains supplementary material available at 10.1186/s12873-020-00388-x.
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Affiliation(s)
- J Mohindru
- Air Ambulance Kent, Surrey and Sussex, Redhill Airfield Redhill Aerodrome, Redhill, Surrey, RH1 5YP, UK
| | - J E Griggs
- Air Ambulance Kent, Surrey and Sussex, Redhill Airfield Redhill Aerodrome, Redhill, Surrey, RH1 5YP, UK
| | - R de Coverly
- Air Ambulance Kent, Surrey and Sussex, Redhill Airfield Redhill Aerodrome, Redhill, Surrey, RH1 5YP, UK
| | - R M Lyon
- Air Ambulance Kent, Surrey and Sussex, Redhill Airfield Redhill Aerodrome, Redhill, Surrey, RH1 5YP, UK.,University of Surrey, Duke of Kent Building, Guildford, School of Health Sciences, Guildford, GU2 7XH, UK
| | - E Ter Avest
- Air Ambulance Kent, Surrey and Sussex, Redhill Airfield Redhill Aerodrome, Redhill, Surrey, RH1 5YP, UK. .,Department of Emergency Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
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Yeom SR, Kim OH, Lee KH. Future development of helicopter emergency medical services in Korea. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2020. [DOI: 10.5124/jkma.2020.63.4.199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
This paper discusses the future development of air ambulance operations in Korea. Helicopter emergency medical services are a useful means of transporting critically ill patients to the right hospital, at the right time. It is an important element of the emergency medical system to treat acute diseases at the scene, or in transit. For more efficient operations of the emergency medical helicopters (air ambulances or the so-called ‘Doctor Helgi’ in Korea), various challenges are faced. These include, the expansion of air ambulance bases, proper placement of rendezvous points (landing point), increase of field transport requests, and the operation of night missions. First, it is necessary to reduce the disparity in the benefits of emergency medical care for critically ill patients through the expansion of helicopter bases. Second, through the advancement of joint operations of the pan-ministerial emergency medical helicopters, the time from dispatch to helicopter take-off should be minimized, and a quality improvement program for air transportation should be carried out. Third, it is necessary to increase the number of insufficient rendezvous points and ensure the safety of the helicopters during takeoff and landing, to activate field transportation. Finally, the safety of patients and medical staff should be secured through the systematic preparation of the air transport system for future night missions. To solve these tasks, an appropriate legal system for helicopter emergency medical service is required. Based on the improved system, it is expected that everyone will enjoy equal rights for health, regardless of the regions.
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Arikan AA, Selçuk E, Bayraktar FA. Predicting Outcomes of Penetrating Cardiovascular Injuries at a Rural Center by Different Scoring Systems. Braz J Cardiovasc Surg 2020; 35:198-205. [PMID: 32369301 PMCID: PMC7199982 DOI: 10.21470/1678-9741-2019-0403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To compare the anatomical and physiological scoring systems and the outcomes of surgical management of penetrating cardiovascular trauma at a rural center. METHODS Seventy-seven patients underwent emergency surgery at our center between January/2012 and October/2018 due to penetrating cardiovascular trauma. Injury Severity Score (ISS), Revised Trauma Score (RTS), New Injury Severity Score (NISS), and Trauma and Injury Severity Score (TRISS) were calculated. The validation of these risk scores to predict mortality was assessed by the area under the receiver operating characteristic curve analysis. RESULTS All trauma scores were correlated with mortality. As ISS, NISS, and TRISS values increased and RTS values decreased, the mortality rate increased. The area under the curve (AUC) in the receiver operating characteristic curve analysis was 0.943 for TRISS, 0.915 for RTS, 0.890 for ISS, and 0.896 for NISS (P<0.001 for each). Logistic regression analysis revealed that scores were correlated with mortality (P<0.001 for each). By investigating cardiac injuries alone, only TRISS and RTS results correlated with mortality for cardiac injuries (Mann-Whitney U test, P=0.003 and P=0.01, respectively). The AUC was only statistically significant for TRISS and RTS (AUC=0.929, P<0.05 for both). For vascular injuries, all the scores were significantly correlated with in-hospital mortality (Mann-Whitney U test, P<0.001 for each). TRISS had the highest AUC (AUC=0.946, P<0.001). CONCLUSION TRISS has the highest predictivity for in-hospital mortality in patients with penetrating cardiovascular trauma.
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Affiliation(s)
- Ali Ahmet Arikan
- Kocaeli University Medical Faculty Department of Cardiovascular Surgery Kocaeli Turkey Department of Cardiovascular Surgery, Kocaeli University Medical Faculty, Kocaeli, Turkey
| | - Emre Selçuk
- Muş State Hospital Department of Cardiovascular Surgery Muş Turkey Department of Cardiovascular Surgery, Muş State Hospital, Muş, Turkey
| | - Fatih Avni Bayraktar
- Muş State Hospital Department of Cardiovascular Surgery Muş Turkey Department of Cardiovascular Surgery, Muş State Hospital, Muş, Turkey
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