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Kondo Y, Fukuda T, Uchimido R, Kashiura M, Kato S, Sekiguchi H, Zamami Y, Hifumi T, Hayashida K. Advanced Life Support vs. Basic Life Support for Patients With Trauma in Prehospital Settings: A Systematic Review and Meta-Analysis. Front Med (Lausanne) 2021; 8:660367. [PMID: 33842515 PMCID: PMC8032986 DOI: 10.3389/fmed.2021.660367] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 03/01/2021] [Indexed: 12/12/2022] Open
Abstract
Background: Advanced Life Support (ALS) is regarded to be associated with improved survival in pre-hospital trauma care when compared to Basic Life Support (BLS) irrespective of lack of evidence. The aim of this study is to ascertain ALS improves survival for trauma in prehospital settings when compared to BLS. Methods: We searched PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials for published controlled trials (CTs), and observational studies that were published until Aug 2017. The population of interest were adults (>18 years old) trauma patients who were transported by ground transportation and required resuscitation in prehospital settings. We compared outcomes between the ALS and BLS groups. The primary outcome was in-hospital mortality and secondary outcomes were neurological outcome and time spent on scene. Results: We identified 2,502 studies from various databases and 10 studies were included in the analysis (two CTs, and eight observational studies). The outcomes were not statistically significant between the ALS and BLS groups (pooled OR 1.14; 95% CI 0.95 to 1.36 for mortality, pooled OR 1.12; 95% CI 0.88 to 1.42 for good neurological outcomes, pooled mean difference −0.96; 95% CI−6.64 to 4.72 for on-scene time) in CTs. In observational studies, ALS prolonged on-scene time and increased mortality (pooled OR 1.56; 95% CI: 1.31 to 1.86 for mortality, and pooled mean difference, 1.26; 95% CI: 0.07 to 2.45 for on-scene time). Conclusions: In prehospital settings, the present study showed no advantages of ALS on the outcomes in patients with trauma compared to BLS.
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Affiliation(s)
- Yutaka Kondo
- Department of Emergency and Critical Care Medicine, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Tatsuma Fukuda
- Department of Emergency and Critical Care Medicine, University of the Ryukyus, Okinawa, Japan
| | - Ryo Uchimido
- Department of Intensive Care Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masahiro Kashiura
- Department of Emergency and Critical Care Medicine, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Soichiro Kato
- Department of Trauma and Critical Care Medicine, Kyorin University School of Medicine, Tokyo, Japan
| | - Hiroshi Sekiguchi
- Department of Emergency and Critical Care Medicine, University of the Ryukyus, Okinawa, Japan
| | - Yoshito Zamami
- Department of Clinical Pharmacology and Therapeutics, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Toru Hifumi
- Department of Emergency and Critical Care Medicine, St. Lukes International Hospital, Tokyo, Japan
| | - Kei Hayashida
- Department of Emergency Medicine, Feinstein Institutes for Medical Research, Northwell Health, New York, NY, United States
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Farrell MS, Emery B, Caplan R, Getchell J, Cipolle M, Bradley KM. Outcomes with advanced versus basic life support in blunt trauma. Am J Surg 2020; 220:783-786. [DOI: 10.1016/j.amjsurg.2020.01.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 01/06/2020] [Accepted: 01/08/2020] [Indexed: 12/01/2022]
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Tønsager K, Rehn M, Ringdal KG, Lossius HM, Virkkunen I, Østerås Ø, Røislien J, Krüger AJ. Collecting core data in physician-staffed pre-hospital helicopter emergency medical services using a consensus-based template: international multicentre feasibility study in Finland and Norway. BMC Health Serv Res 2019; 19:151. [PMID: 30849977 PMCID: PMC6408770 DOI: 10.1186/s12913-019-3976-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 02/26/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Comparison of services and identification of factors important for favourable patient outcomes in emergency medical services (EMS) is challenging due to different organization and quality of data. The purpose of the present study was to evaluate the feasibility of physician-staffed EMS (p-EMS) to collect patient and system level data by using a consensus-based template. METHODS The study was an international multicentre observational study. Data were collected according to a template for uniform reporting of data from p-EMS using two different data collection methods; a standard and a focused data collection method. For the standard data collection, data were extracted retrospectively for one year from all FinnHEMS bases and for the focused data collection, data were collected prospectively for six weeks from four selected Norwegian p-EMS bases. Completeness rates for the two data collection methods were then compared and factors affecting completeness rates and template feasibility were evaluated. Standard Chi-Square, Fisher's Exact Test and Mann-Whitney U Test were used for group comparison of categorical and continuous data, respectively, and Kolomogorov-Smirnov test for comparison of distributional properties. RESULTS All missions with patient encounters were included, leaving 4437 Finnish and 128 Norwegian missions eligible for analysis. Variable completeness rates indicated that physiological variables were least documented. Information on pain and respiratory rate were the most frequently missing variables with a standard data collection method and systolic blood pressure was the most missing variable with a focused data collection method. Completeness rates were similar or higher when patients were considered severely ill or injured but were lower for missions with short patient encounter. When a focused data collection method was used, completeness rates were higher compared to a standard data collection method. CONCLUSIONS We found that a focused data collection method increased data capture compared to a standard data collection method. The concept of using a template for documentation of p-EMS data is feasible in physician-staffed services in Finland and Norway. The greatest deficiencies in completeness rates were evident for physiological parameters. Short missions were associated with lower completeness rates whereas severe illness or injury did not result in reduced data capture.
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Affiliation(s)
- Kristin Tønsager
- The Norwegian Air Ambulance Foundation, Oslo, Norway. .,Department of Anaesthesiology and Intensive Care, Stavanger University Hospital, Stavanger, Norway. .,Department of Health Studies, University of Stavanger, Stavanger, Norway.
| | - Marius Rehn
- The Norwegian Air Ambulance Foundation, Oslo, Norway.,Department of Health Studies, University of Stavanger, Stavanger, Norway.,Pre-hospital Division, Air Ambulance Department, Oslo University Hospital, Oslo, Norway
| | - Kjetil G Ringdal
- Department of Anesthesiology, Vestfold Hospital Trust, Tønsberg, Norway.,Division of Emergencies and Critical Care, Department of Anesthesiology, Oslo University Hospital, Oslo, Norway.,Norwegian Trauma Registry, Oslo University Hospital, Oslo, Norway
| | - Hans Morten Lossius
- The Norwegian Air Ambulance Foundation, Oslo, Norway.,Department of Health Studies, University of Stavanger, Stavanger, Norway
| | | | - Øyvind Østerås
- Department of Anaesthesiology and Intensive Care, Haukeland University Hospital, Bergen, Norway
| | - Jo Røislien
- The Norwegian Air Ambulance Foundation, Oslo, Norway.,Department of Health Studies, University of Stavanger, Stavanger, Norway
| | - Andreas J Krüger
- The Norwegian Air Ambulance Foundation, Oslo, Norway.,Department of Emergency Medicine and Pre-Hospital Services, St. Olavs Hospital, Trondheim, Norway
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Hirano Y, Abe T, Tanaka H. Efficacy of the presence of an emergency physician in prehospital major trauma care: A nationwide cohort study in Japan. Am J Emerg Med 2018; 37:1605-1610. [PMID: 30442432 DOI: 10.1016/j.ajem.2018.11.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 11/06/2018] [Accepted: 11/08/2018] [Indexed: 11/26/2022] Open
Abstract
PURPOSE The beneficial effect of the presence of an emergency physician in prehospital major trauma care is controversial. The aim in this study is to assess whether an emergency physician on scene can improve survival outcome of critical trauma patients. METHODS This retrospective cohort study was conducted by using nationwide trauma registry data between 2004 and 2013 in Japan. Severe trauma patients (injury severity score (ISS) ≥ 16) who were transported directly to the hospital from the injury site were included in our analysis. Patients who were predicted to be untreatable (abbreviated injury score (AIS) = 6 and/or cardiopulmonary arrest at least one time before hospital arrival) were excluded. Participants were divided into either a physician or paramedics group based on the prehospital practitioner. The primary outcome was survival rate at discharge. Multivariable logistic regression analysis was performed to compare the outcome with adjustment for age, gender, ISS, cause of injury, and pre-hospital vital signs. RESULTS A total of 30,283 patients were eligible for the selection criteria (physician: 1222, paramedics: 29,061). Overall, 172 patients (14.1%) died in the physician group compared to 3508 patients (12.1%) in the paramedics group. Patients in the physician group had higher ISSs than those in the paramedics group. In multivariable logistic regression, the physician group had an odds ratio (OR) of 1.16 (95% confidence interval (CI) = 0.97 to 1.40, p = 0.11) for in-hospital survival. CONCLUSIONS Our results failed to show a difference in survival at discharge between non-physician-staffed ambulances and physician-staffed ambulances.
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Affiliation(s)
- Yohei Hirano
- Department of Emergency and Critical Care Medicine, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu, Chiba, Japan.
| | - Toshikazu Abe
- Department of General Medicine, Juntendo University, 2-1-1, Hongo, Bunkyo-ku, Tokyo, Japan; Department of Health Services Research, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Japan
| | - Hiroshi Tanaka
- Department of Emergency and Critical Care Medicine, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu, Chiba, Japan.
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