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Gustavo de Paulo L, Massago M, Iora PH, Bitencourt MR, Gurgel SJT, Silva MD, Toledo ERDS, Gabella JL, Costa JLL, Rossoni DF, Hoff J, Joiner AP, de Andrade L. Confronting mobile phone signal coverage and helicopter emergency medical service travel time: A geospatial analysis in the northwest macro-region of Paraná State, Brazil. TRAFFIC INJURY PREVENTION 2024:1-7. [PMID: 38860881 DOI: 10.1080/15389588.2024.2355584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 05/10/2024] [Indexed: 06/12/2024]
Abstract
OBJECTIVE The aim of this study was to conduct a detailed geospatial analysis of mobile phone signal coverage in the northwest macro-region of Paraná State, Brazil, seeking to identify areas where limitations in coverage may be related to lengthy travel times of the helicopter emergency medical service (HEMS) for the assistance of victims of road traffic injuries (RTIs). METHODS An observational study was conducted to examine mobile phone signal coverage and HEMS travel times from 2017 to 2021. HEMS travel times were categorized into four groups: T1 (0-15 min), T2 (16-30 min), T3 (31-45 min), and T4 (over 45 min). Empirical Bayesian Kriging was used to map areas with low mobile signal coverage. The Kruskal-Wallis test and Dwass-Steel-Critchlow-Fligner comparative analyses were performed to explore how mobile signal coverage relates to HEMS travel times to RTI locations. RESULTS There were 470 occurrences of RTIs attended by HEMS, of which 108 (23%) resulted in on-site fatalities. Among these deaths, 47 (26.85%) occurred in areas with low mobile phone signal coverage ("shadow areas"). Low mobile phone signal coverage identified at 175 (37.24%) RTIs locations, was unevenly distributed across the macro-region. The lowest medians of mobile signal quality were predominantly found in areas with HEMS travel times exceeding 30 min, corresponding to signal strength values of -98.44 (T3) and -100.75 (T4) dBm. This scenario represents a challenge for effective communication to activate HEMS. In the multiple comparison analysis among travel time groups, significant differences were observed between T1 and T2 (p < 0.001), T1 and T3 (p < 0.001), T1 and T4 (p < 0.001), and T2 and T3 (p < 0.001), indicating a potential association between lower mobile phone signal coverage and longer HEMS travel times. CONCLUSION It can be concluded that poor mobile phone signals in remote areas can hinder HEMS activation, potentially delaying the start of treatment for RTIs. Identification of the shadow areas can help communication and health managers in designing and implementing the necessary changes to improve mobile phone signal coverage and consequently reduce delays in the initial response to RTIs.
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Affiliation(s)
- Luiz Gustavo de Paulo
- Postgraduate Program in Management, Technology and Innovation in Urgency and Emergency, State University of Maringá, Maringá, Brazil
- Group of studies in digital technologies and geoprocessing in health, State University of Maringá, Maringá, Brazil
| | - Miyoko Massago
- Group of studies in digital technologies and geoprocessing in health, State University of Maringá, Maringá, Brazil
- Postgraduate Program in Health Sciences, State University of Maringá, Maringá, Brazil
| | - Pedro Henrique Iora
- Group of studies in digital technologies and geoprocessing in health, State University of Maringá, Maringá, Brazil
- Department of Medicine, State University of Maringá, Maringá, Brazil
| | - Marcos Rogério Bitencourt
- Group of studies in digital technologies and geoprocessing in health, State University of Maringá, Maringá, Brazil
- Postgraduate Program in Health Sciences, State University of Maringá, Maringá, Brazil
| | - Sanderland José Tavares Gurgel
- Group of studies in digital technologies and geoprocessing in health, State University of Maringá, Maringá, Brazil
- Department of Medicine, State University of Maringá, Maringá, Brazil
| | - Marcelo da Silva
- Department of Nursing, State University of Maringá, Maringá, Brazil
| | - Erika Rodrigues da Silva Toledo
- Postgraduate Program in Management, Technology and Innovation in Urgency and Emergency, State University of Maringá, Maringá, Brazil
| | - Júlia Loverde Gabella
- Postgraduate Program in Management, Technology and Innovation in Urgency and Emergency, State University of Maringá, Maringá, Brazil
- Group of studies in digital technologies and geoprocessing in health, State University of Maringá, Maringá, Brazil
| | - Juliana Lourenço Lopes Costa
- Group of studies in digital technologies and geoprocessing in health, State University of Maringá, Maringá, Brazil
- Department of Medicine, University Center of Maringá, Maringá, Brazil
| | | | - John Hoff
- Department of Emergency Medicine, Duke Global Health Institute, Duke University, Durham, North Carolinal
| | - Anjni Patel Joiner
- Department of Emergency Medicine, Duke Global Health Institute, Duke University, Durham, North Carolinal
| | - Luciano de Andrade
- Postgraduate Program in Management, Technology and Innovation in Urgency and Emergency, State University of Maringá, Maringá, Brazil
- Group of studies in digital technologies and geoprocessing in health, State University of Maringá, Maringá, Brazil
- Postgraduate Program in Health Sciences, State University of Maringá, Maringá, Brazil
- Department of Medicine, State University of Maringá, Maringá, Brazil
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Kolaparambil Varghese LJ, Völlering JJ, De Robertis E, Hinkelbein J, Schmitz J, Warnecke T. Efficacy of endotracheal intubation in helicopter cabin vs. ground: a systematic review and meta-analysis. Scand J Trauma Resusc Emerg Med 2024; 32:40. [PMID: 38730289 PMCID: PMC11084009 DOI: 10.1186/s13049-024-01213-1] [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: 12/09/2023] [Accepted: 04/25/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Pre-hospital endotracheal intubation (ETI) is a sophisticated procedure with a comparatively high failure rate. Especially, ETI in confined spaces may result in higher difficulty, longer times, and a higher failure rate. This study analyses if Helicopter Emergency Medical Services (HEMS) intubation (time-to) success are influenced by noise, light, and restricted space in comparison to ground intubation. Available literature reporting these parameters was very limited, thus the reported differences between ETI in helicopter vs. ground by confronting parameters such as time to secure airway, first pass success rate and Cormack-Lehane Score were analysed. METHODS A systematic review and meta-analysis were conducted using PUBMED, EMBASE, Cochrane Library, and Ovid on October 15th, 2022. The database search provided 2322 studies and 6 studies met inclusion and quality criteria. The research was registered with the International Prospective Register of Systematic Reviews (CRD42022361793). RESULTS A total of six studies were selected and analysed as part of the systematic review and meta-analysis. The first pass success rate of ETI was more likely to fail in the helicopter setting as compared to the ground (82,4% vs. 87,3%), but the final success rate was similar between the two settings (96,8% vs. 97,8%). The success rate of intubation in literature was reported higher in physician-staffed HEMS than in paramedic-staffed HEMS. The impact of aircraft type and location inside the vehicle on intubation success rates was inconclusive across studies. The meta-analysis revealed inconsistent results for the mean duration of intubation, with one study reporting shorter intubation times in helicopters (13,0s vs.15,5s), another reporting no significant differences (16,5s vs. 16,8s), and a third reporting longer intubation times in helicopters (16,1s vs. 15,0s). CONCLUSION Further research is needed to assess the impact of environmental factors on the quality of ETI on HEMS. While the success rate of endotracheal intubation in helicopters vs. on the ground is not significantly different, the duration and time to secure the airway, and Cormack-Lehane Score may be influenced by environmental factors. However, the limited number of studies reporting on these factors highlights the need for further research in this area.
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Affiliation(s)
- Lydia Johnson Kolaparambil Varghese
- University Department of Anaesthesiology, Intensive Care Medicine, and Emergency Medicine, Johannes Wesling Klinikum Minden, University Hospital Ruhr-University Bochum, Minden, Germany.
- European Society of Aerospace Medicine (ESAM), Cologne, Germany.
| | - Jan-Jakob Völlering
- Department of Mathematics and Informatics, University of Osnabrück, Osnabrück, Germany
| | - Edoardo De Robertis
- Division of Anaesthesia, Analgesia, and Intensive Care, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Jochen Hinkelbein
- University Department of Anaesthesiology, Intensive Care Medicine, and Emergency Medicine, Johannes Wesling Klinikum Minden, University Hospital Ruhr-University Bochum, Minden, Germany
- European Society of Aerospace Medicine (ESAM), Cologne, Germany
| | - Jan Schmitz
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, Germany
- Department of Sleep and Human Factors Research, German Aerospace Centre, Cologne, Germany
| | - Tobias Warnecke
- Intensive Care, Emergency Medicine, and Pain Therapy, University Clinic of Anaesthesiology, Klinikum Oldenburg, Oldenburg, Germany
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Okada Y, Fujita K, Ogura T, Motomura T, Fukuyama Y, Banshotani Y, Tokuda R, Ijuin S, Inoue A, Takahashi H, Yokobori S. Novel and innovative resuscitation systems in Japan. Resusc Plus 2024; 17:100541. [PMID: 38260120 PMCID: PMC10801325 DOI: 10.1016/j.resplu.2023.100541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024] Open
Abstract
Aim Out-of-hospital cardiac arrest (OHCA) is a life-threatening emergency that requires rapid and efficient intervention. Recently, several novel approaches have emerged and have been incorporated into resuscitation systems in some local areas of Japan. This review describes innovative resuscitation systems and highlights their strengths. Main text First, we discuss the deployment of a physician-staffed ambulance, in which emergency physicians offer advanced resuscitation to patients with OHCA on site. In addition, we describe the experimental practice of extracorporeal membrane oxygenation (ECPR) in a prehospital setting. Second, we describe a physician-staffed helicopter, wherein a medical team provides advanced resuscitation at the scene. We also explain their initiative to provide early ECPR, even in remote areas. Finally, we provide an overview of the "hybrid ER" system which is a "one-fits-all" resuscitation bay equipped with computed tomography and fluoroscopy equipment. This system is expected to help swiftly identify and rule out irreversible causes of cardiac arrest, such as massive subarachnoid hemorrhage, and implement ECPR without delay. Conclusion Although these revolutionary approaches may improve the outcomes of patients with OHCA, evidence of their effectiveness remains limited. In addition, it is crucial to ensure cost-effectiveness and sustainability. We will continue to work diligently to assess the effectiveness of these systems and focus on the development of cost-effective and sustainable systems.
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Affiliation(s)
- Yohei Okada
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
- Department of Preventive Services, Kyoto University, Kyoto, Japan
| | - Kensuke Fujita
- Department of Emergency Medicine and Critical Care Medicine, Tochigi Prefectural Emergency and Critical Care Center, Imperial Gift Foundation Saiseikai Utsunomiya Hospital, Japan
| | - Takayuki Ogura
- Department of Emergency Medicine and Critical Care Medicine, Tochigi Prefectural Emergency and Critical Care Center, Imperial Gift Foundation Saiseikai Utsunomiya Hospital, Japan
| | - Tomokazu Motomura
- Shock and Trauma Center/Hokusoh HEMS Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Yuita Fukuyama
- Shock and Trauma Center/Hokusoh HEMS Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Yuki Banshotani
- Tajima Emergency and Critical Care Medical Center, Hyogo, Japan
| | - Rina Tokuda
- Tajima Emergency and Critical Care Medical Center, Hyogo, Japan
| | - Shinichi Ijuin
- Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, Hyogo, Japan
| | - Akihiko Inoue
- Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, Hyogo, Japan
| | | | - Shoji Yokobori
- Department of Emergency and Critical Care Medicine Graduate School of Nippon Medical School, Tokyo, Japan
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Nagasawa H, Omori K, Muramatsu KI, Takeuchi I, Ohsaka H, Ishikawa K, Yanagawa Y. Outcomes of prehospital traumatic cardiac arrest managed by helicopter emergency medical service personnel in Japan: a registry data analysis. Int J Emerg Med 2023; 16:70. [PMID: 37828443 PMCID: PMC10568871 DOI: 10.1186/s12245-023-00550-9] [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: 08/17/2023] [Accepted: 10/03/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Traumatic cardiac arrest (TCA) is associated with poor outcomes. Helicopter emergency medical services (HEMSs) are often used to transport critically ill patients to hospitals. However, the role of HEMS in the treatment of TCA remains unclear. Therefore, in this study, we aimed to determine the current status of patients with prehospital TCA managed by HEMS personnel in Japan and compare the outcomes of patients who experienced TCA before and after the arrival of HEMS. METHODS The Japanese Society for Aeromedical Services registry data of patients managed by HEMS personnel from April 2015 to March 2020 were analyzed in this retrospective cohort study. HEMS arrival and physicians' interventions at the scene were the variables of interest. The survival rate and neurological outcomes at 28 days after injury were analyzed. RESULTS Of the 55 299 registered patients, 722 who experienced prehospital TCA were included in the analysis. The distribution of first-witnessed TCA was as follows: pre-emergency medical service (EMS) arrival (n = 426/722, 60.3%), after EMS arrival (n = 113/722, 16.0%), and after HEMS arrival (n = 168/722, 23.8%). The 28-day survival rate was 6.2% (n = 44/706), with a cerebral performance category of 1 or 2 in 18 patients. However, patients who experienced TCA after receiving interventions provided by physicians before HEMS arrival had the worst outcomes, with only 0.6% of them surviving with favorable neurological outcomes. Multivariable analysis revealed that securing the intravenous route by the EMS team (adjusted odds ratio: 2.43, 95% confidence interval [CI]: 1.11-5.30) and tranexamic acid infusion by the HEMS team (adjusted odds ratio: 2.78, 95% CI: 1.16-6.64) may have increased the return of spontaneous circulation (ROSC) rate. CONCLUSIONS The results of our study were similar to those reported in previous studies with regards to the use of HEMS in Japan for transporting patients with TCA. Our findings suggest that in patients with severe trauma, cardiac arrest after initiation of HEMS, the highest level of prehospital medical intervention, may be associated with an inferior prognosis. Tracheal intubation and administration of tranexamic acid by the EMS team may increase the rate of ROSC in TCA.
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Affiliation(s)
- Hiroki Nagasawa
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, 1129 Nagaoka, Izunokuni City, Shizuoka 410-2295 Japan
| | - Kazuhiko Omori
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, 1129 Nagaoka, Izunokuni City, Shizuoka 410-2295 Japan
| | - Ken-ichi Muramatsu
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, 1129 Nagaoka, Izunokuni City, Shizuoka 410-2295 Japan
| | - Ikuto Takeuchi
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, 1129 Nagaoka, Izunokuni City, Shizuoka 410-2295 Japan
| | - Hiromichi Ohsaka
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, 1129 Nagaoka, Izunokuni City, Shizuoka 410-2295 Japan
| | - Kouhei Ishikawa
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, 1129 Nagaoka, Izunokuni City, Shizuoka 410-2295 Japan
| | - Youichi Yanagawa
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, 1129 Nagaoka, Izunokuni City, Shizuoka 410-2295 Japan
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Ishii W, Hitosugi M, Kandori K, Miyaguni M, Iizuka R. Increased CT Use and No Change in Injury Severity among Child Motor Vehicle Victims: A National Trauma Database Study in Japan. Healthcare (Basel) 2023; 11:healthcare11091240. [PMID: 37174781 PMCID: PMC10178139 DOI: 10.3390/healthcare11091240] [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: 02/20/2023] [Revised: 04/12/2023] [Accepted: 04/25/2023] [Indexed: 05/15/2023] Open
Abstract
The number of fatalities associated with traffic accidents has been declining owing to improvements in vehicle safety performance and changes in the law. However, injuries in children can lead to social and economic losses. We examined 10-year changes in the characteristics of traffic trauma among pediatric motor vehicle passengers by analyzing data from the Japan Trauma Data Bank (JTDB). Among the 36,715 injured motor vehicle passengers under the age of 15 years who were registered in the JTDB from 2004 to 2019, we compared the groups injured during 2004-2007 (n = 94) and 2017-2019 (n = 203). Physiologically, the 2004-2007 group had a lower body temperature and Glasgow Coma Scale score as well as a higher mortality. Anatomical severity was higher in the 2004-2007 group for the head, face, and neck, according to the Abbreviated Injury Scale. In terms of treatment, only craniotomy as a primary surgery was significantly lower in the 2017-2019 group. The 2017-2019 group had significantly higher rates of receiving whole-body computed tomography (CT). Because the rate of performing CT has increased, with no changes in the injury severities of the trunk and extremities, limiting the number of CT examinations is suggested for pediatric motor vehicle passengers involved in road traffic collisions. The severity of trunk and extremity injuries has not improved in more than 10 years; further preventive measures for these injuries should be considered.
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Affiliation(s)
- Wataru Ishii
- Emergency of Medicine, Critical Care Center, Kyoto Daini Red Cross Hospital, Haruobi, Kamazamarutamachi, Kamigyo, Kyoto 602-8026, Japan
| | - Masahito Hitosugi
- Department of Legal Medicine, Shiga University of Medical Science, Tsukinowa, Seta, Otsu 520-2192, Japan
| | - Kenji Kandori
- Emergency of Medicine, Critical Care Center, Kyoto Daini Red Cross Hospital, Haruobi, Kamazamarutamachi, Kamigyo, Kyoto 602-8026, Japan
| | - Michitaro Miyaguni
- Emergency of Medicine, Critical Care Center, Kyoto Daini Red Cross Hospital, Haruobi, Kamazamarutamachi, Kamigyo, Kyoto 602-8026, Japan
| | - Ryoji Iizuka
- Emergency of Medicine, Critical Care Center, Kyoto Daini Red Cross Hospital, Haruobi, Kamazamarutamachi, Kamigyo, Kyoto 602-8026, Japan
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Guinzburg A, Gelikas S, Tsur AM, Nadler R, Sorkin A, Avital G, Radomislensky I, Bodas M, Segal D, Benov A, Chen J. The association between helicopter emergency medical services and early casualty survival: a nationwide study. Eur J Emerg Med 2022; 29:397-403. [PMID: 35900102 DOI: 10.1097/mej.0000000000000940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Helicopter emergency medical services (HEMS) allow for shorter transport duration in long-distance evacuations and facilitate advanced en-route medical care access. Studies comparing HEMS with ground emergency medical services (GEMS), including the outcome of prehospital mortality, are lacking. OBJECTIVE This study aimed to evaluate the association between HEMS and early mortality in Israel. SETTING A retrospective cohort study was conducted of the cross-referenced Israel Defense Forces Trauma Registry and Israel National Trauma Registry databases. OUTCOME MEASURES AND ANALYSIS Univariable logistic regression was used to assess the association between HEMS and early mortality, defined as mortality within 1 day of the injury. Regression analysis was further performed stratifying by event type (military or civilian) or type of injury (penetrating or nonpenetrating). RESULTS A total of 2344 casualties were included in the study, of whom 756 (32.3%) were evacuated by air. Early mortality rates were 90/1588 (5.7%) and 37/756 (4.9%) in GEMS and HEMS groups, respectively. Regression analysis found no significant analysis between HEMS and early mortality [OR, 0.86 (95% CI, 0.57-1.26)]. Stratified by event type, a nonsignificant association between HEMS and early mortality was demonstrated for combat [OR, 1.69 (95% CI, 0.79-3.92)] and noncombat [OR, 0.73 (95% CI, 0.4-1.25)] events. HEMS was associated with decreased early mortality among casualties with a penetrating injury [OR, 0.59 (95% CI, 0.34-0.98)] but not associated with early mortality among casualties with a nonpenetrating injury [OR, 0.84 (95% CI, 0.43-1.52)]. CONCLUSION HEMS was not associated with a decrease in early mortality among trauma casualties in this study encompassing the prehospital and hospital scenes. There was a positive trend and a decrease in mortality from penetrating injuries. Further research to ascertain which casualties benefit from HEMS is warranted and will allow for more precise use of this expensive resource.
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Affiliation(s)
- Ariel Guinzburg
- The Trauma and Combat Medicine Branch, Surgeon General's Headquarters, Israel Defense Forces, Ramat Gan
| | - Shaul Gelikas
- The Trauma and Combat Medicine Branch, Surgeon General's Headquarters, Israel Defense Forces, Ramat Gan
| | - Avishai M Tsur
- The Trauma and Combat Medicine Branch, Surgeon General's Headquarters, Israel Defense Forces, Ramat Gan
- Department of Medicine 'B', Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Affiliated to Sackler School of Medicine, Tel Aviv
| | - Roy Nadler
- The Trauma and Combat Medicine Branch, Surgeon General's Headquarters, Israel Defense Forces, Ramat Gan
- Department of Medicine 'B', Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Affiliated to Sackler School of Medicine, Tel Aviv
| | - Alex Sorkin
- The Trauma and Combat Medicine Branch, Surgeon General's Headquarters, Israel Defense Forces, Ramat Gan
- Department of Plastic Surgery, Shamir Medical Center, Zerifin
| | - Guy Avital
- The Trauma and Combat Medicine Branch, Surgeon General's Headquarters, Israel Defense Forces, Ramat Gan
- Division of Anesthesia, Intensive Care, and Pain Management, Tel-Aviv Medical Center, Tel-Aviv University, Tel-Aviv
| | - Irina Radomislensky
- The National Center for Trauma and Emergency Medicine Research, The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel-Hashomer
| | - Moran Bodas
- The National Center for Trauma and Emergency Medicine Research, The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel-Hashomer
- Department of Emergency Management and Disaster Medicine, School of Public Health, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv
| | - David Segal
- Meir Medical Center, Kfar Saba
- Sackler School of Medicine, Tel Aviv University, Tel Aviv
| | - Avi Benov
- The Trauma and Combat Medicine Branch, Surgeon General's Headquarters, Israel Defense Forces, Ramat Gan
- The Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Jacob Chen
- The Trauma and Combat Medicine Branch, Surgeon General's Headquarters, Israel Defense Forces, Ramat Gan
- Meir Medical Center, Kfar Saba
- Sackler School of Medicine, Tel Aviv University, Tel Aviv
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Reimer AP, Schiltz NK, Koroukian SM. High-risk diagnosis combinations in patients undergoing interhospital transfer: a retrospective observational study. BMC Emerg Med 2022; 22:187. [PMID: 36418974 PMCID: PMC9685892 DOI: 10.1186/s12873-022-00742-1] [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: 06/24/2022] [Accepted: 11/04/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND There is limited research on individual patient characteristics, alone or in combination, that contribute to the higher levels of mortality in post-transfer patients. The purpose of this work is to identify significant combinations of diagnoses that identify subgroups of post-interhospital transfer patients experiencing the highest levels of mortality. METHODS This was a retrospective cross-sectional study using structured electronic health record data from a regional health system between 2010-2017. We employed a machine learning approach, association rules mining using the Apriori algorithm to identify diagnosis combinations. The study population includes all patients aged 21 and older that were transferred within our health system from a community hospital to one of three main receiving hospitals. RESULTS Overall, 8893 patients were included in the analysis. Patients experiencing mortality post-transfer were on average older (70.5 vs 62.6 years) and on average had more diagnoses in 5 of the 6 diagnostic subcategories. Within the diagnostic subcategories, most diagnoses were comorbidities and active medical problems, with hypertension, atrial fibrillation, and acute respiratory failure being the most common. Several combinations of diagnoses identified patients that exceeded 50% post-interhospital transfer mortality. CONCLUSIONS Comorbid burden, in combination with active medical problems, were most predictive for those experiencing the highest rates of mortality. Further improving patient level prognostication can facilitate informed decision making between providers and patients to shift the paradigm from transferring all patients to higher level care to only transferring those who will benefit or desire continued care, and reduce futile transfers.
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Affiliation(s)
- Andrew P. Reimer
- grid.67105.350000 0001 2164 3847Frances Payne Bolton School of Nursing, Case Western Reserve University, 2120 Cornell Dr10900 Euclid Ave, Cleveland, OH 44106, 216-368-7570 USA ,grid.239578.20000 0001 0675 4725Critical Care Transport, Cleveland Clinic, 9800 Euclid Ave, Cleveland, OH USA
| | - Nicholas K. Schiltz
- grid.67105.350000 0001 2164 3847Frances Payne Bolton School of Nursing, Case Western Reserve University, 2120 Cornell Dr10900 Euclid Ave, Cleveland, OH 44106, 216-368-7570 USA
| | - Siran M. Koroukian
- grid.67105.350000 0001 2164 3847Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, OH USA
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Comparative Study on the Outcome of Trauma Patients Transferred by Doctor Helicopters and Ground Ambulance in South Korea. Disaster Med Public Health Prep 2022; 17:e290. [PMID: 36373274 DOI: 10.1017/dmp.2022.211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The purpose of this study was to analyze the cost-effectiveness of helicopter emergency medical services (HEMS) for its economic operations in South Korea. METHODS This study targeted trauma patients that were transported by either HEMS or ground emergency medical services (GEMS) from the scene of an accident to a regional emergency medical center. From this patient population, severe trauma patients (injury severity score ISS ≥ 16 points) with a distance travelled from the scene of the injury to the hospital that was 30 km or longer and with analyzable outcome data were extracted and included in this study. Cost-effectiveness was analyzed from survival and efficiency based on medical costs incurred from the pre-hospital setting to hospital discharge. This study included a total of 34 HEMS and 105 GEMS patients with an Injury Severity Score (ISS) ≥ 16 points from a pool of 357 potential patients. RESULTS The survival-to-discharge rate of HEMS was 29 of 34 patients (85.3%) and was significantly higher than that of GEMS, where only 66 of 105 patients (62.8%) survived to discharge (P = 0.024). The expected and the actual mortality was higher in HEMS than it was in GEMS. Statistical significant difference in cost was found between the 2 groups (P = 0.002). CONCLUSIONS The results of the present study indicate the increased discharge rate, survival rate and reduced in hospital mortality of HEMS with reduced admission time. This result association leads to reasonable cost effectiveness and efficient estimates overall.
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Abstract
OBJECTIVES To assess recent advances in interfacility critical care transport. DATA SOURCES PubMed English language publications plus chapters and professional organization publications. STUDY SELECTION Manuscripts including practice manuals and standard (1990-2021) focused on interfacility transport of critically ill patients. DATA EXTRACTION Review of society guidelines, legislative requirements, objective measures of outcomes, and transport practice standards occurred in work groups assessing definitions and foundations of interfacility transport, transport team composition, and transport specific considerations. Qualitative analysis was performed to characterize current science regarding interfacility transport. DATA SYNTHESIS The Task Force conducted an integrative review of 496 manuscripts combined with 120 from the authors' collections including nonpeer reviewed publications. After title and abstract screening, 40 underwent full-text review, of which 21 remained for qualitative synthesis. CONCLUSIONS Since 2004, there have been numerous advances in critical care interfacility transport. Clinical deterioration may be mitigated by appropriate patient selection, pretransport optimization, and transport by a well-resourced team and vehicle. There remains a dearth of high-quality controlled studies, but notable advances in monitoring, en route management, transport modality (air vs ground), as well as team composition and training serve as foundations for future inquiry. Guidance from professional organizations remains uncoupled from enforceable regulations, impeding standardization of transport program quality assessment and verification.
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Factors Associated with Traumatic Diaphragmatic Rupture among Patients with Chest or Abdominal Injury: A Nationwide Study from Japan. J Clin Med 2022; 11:jcm11154462. [PMID: 35956077 PMCID: PMC9369230 DOI: 10.3390/jcm11154462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 07/21/2022] [Accepted: 07/26/2022] [Indexed: 12/10/2022] Open
Abstract
Background: Blunt traumatic diaphragmatic rupture (TDR) is a rare condition that is seen in patients with blunt thoracoabdominal trauma. However, factors that are associated with blunt TDR have not been fully revealed. The purpose of this study was to evaluate the factors that are associated with blunt TDR in trauma patients with a chest or abdominal injury using nationwide trauma registry data in Japan. Method: This study was a retrospective observational study with a 15-year study period from 2004 to 2018. We included trauma patients with a chest or abdominal Abbreviated Injury Score of two or more. We evaluated the relationship between confounding factors such as mechanism of injury and blunt TDR with multivariable logistic regression analysis. Results: This study included 65,110 patients, of whom 496 patients (0.8%) suffered blunt TDR. Factors that were associated with blunt TDR were disturbance of consciousness (adjusted OR [AOR]: 1.639, 95% CI: 1.326–2.026), FAST positive (AOR: 2.120, 95% CI: 1.751–2.567), front seat passenger (AOR: 1.748, 95% CI: 1.129–2.706), and compression injury by heavy object (AOR: 1.677, 95% CI: 1.017–2.765). Conclusion: This study revealed several factors that are associated with blunt TDR. The results of this study may be useful for clinicians when estimating blunt TDR.
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11
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Wake K, Noguchi T, Hishinuma H, Zaitsu M, Kikuchi J, Uchida M, Hayashi K, Machida M, Houzumi H, Hoshiyama E, Takahashi K, Kobashi G, Ono K. Characteristics of patients who received helicopter emergency medical services in Japan from 2012 to 2019: a retrospective analysis of data from Tochigi Prefecture. Scand J Trauma Resusc Emerg Med 2022; 30:25. [PMID: 35410427 PMCID: PMC8996593 DOI: 10.1186/s13049-022-01012-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 03/29/2022] [Indexed: 12/23/2022] Open
Abstract
Background Helicopter Emergency Medical Services (HEMS) has been in operation in Japan since 2001, allowing patients almost anywhere in the nation to receive on-scene emergency treatment from physicians. However, there is insufficient literature on the characteristics of the patients who use Japanese HEMS. Thus, this study aimed to investigate the overall characteristics of patients receiving HEMS care within a single prefecture in Japan.
Methods We retrospectively analyzed the data of 5163 patients—in Tochigi Prefecture—who received HEMS care from 2012 to 2019. Descriptive statistics were used to analyze the following aspects of care: diagnosis, severity, background characteristics, geographical and environmental variables, immediate pre-hospital intervention, transportation type, and short-term clinical outcomes. Results Among 7370 HEMS requests received during the study period, treatment was provided to 5163 patients (1.8 cases per day; 3489 men [67.6%]). Nearly 55% (n = 2856) of patients were aged above 60 years. Age peaks were observed at 0–9 years and 60–69 years. The median distance from the base hospital to the site was 26.7 km. The age-standardized rate of HEMS treatment was 30.3 patients per 100,000 people. Cases of trauma and cardiovascular diseases were the most common (65.3%). Most individuals aged 0–9 years and 60–69 years had neurological disease (seizures accounted for 80.5% of this group) and cardiovascular disease, respectively. The number of patients was similar across all four seasons. After immediate pre-hospital intervention, 81.6% of patients receiving HEMS care were transferred by the helicopter ambulance (53.4% and 28.2% to the base hospital and to other hospitals, respectively). Overall, 56.6% of patients receiving HEMS care were transferred to the base hospital, and the short-term recovery rate was above 75%. Intravenous drip and oxygen administration were the most common pre-hospital interventions (93.1% and 72.7%, respectively). Conclusions This study is the first to describe the overall characteristics of HEMS patients using comprehensive data of all HEMS patients in one prefecture in Japan. Further research using both local- and national-level data is needed to accelerate the understanding of the benefits of HEMS. Supplementary Information The online version contains supplementary material available at 10.1186/s13049-022-01012-6.
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12
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Jitsuiki K, Nagasawa H, Muramatsu KI, Takeuchi I, Ohsaka H, Ishikawa K, Yanagawa Y. The Usefulness of Physician-Staffed Helicopters for Managing Severe Abdominal Trauma Patients. J Emerg Trauma Shock 2022; 15:12-16. [PMID: 35431489 PMCID: PMC9006718 DOI: 10.4103/jets.jets_96_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 10/06/2021] [Accepted: 12/21/2021] [Indexed: 11/14/2022] Open
Abstract
Introduction: We retrospectively investigated prognostic factors for severe abdominal trauma patients evacuated by a physician-staffed helicopter emergency medical service (HEMS) and ground ambulance using the Japan Trauma Data Bank (JTDB). Methods: The study period was from January 2004 to May 2019. The subjects were divided into two groups, according to the type of outcome: the Mortality group, which included patients who ultimately died, and the Survival group, which included patients who obtained a survival outcome. Results: There were 2457 in the Mortality group and 11,326 in the Survival group. When variables that showed statistical significance in the univariate analysis were included in a multivariate analysis, the following variables were identified as significant positive predictors of a fatal outcome: evacuation from the scene, blunt injury, injury severity score, and age; significant negative predictors of a fatal outcome were transportation by the HEMS and revised trauma score. Conclusions: The present study described the usefulness of the HEMS for severe abdominal trauma patients in comparison with ground ambulance transportation using the JTDB.
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Affiliation(s)
- Kei Jitsuiki
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Tokyo, Japan
| | - Hiroki Nagasawa
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Tokyo, Japan
| | - Ken-Ichi Muramatsu
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Tokyo, Japan
| | - Ikuto Takeuchi
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Tokyo, Japan
| | - Hiromichi Ohsaka
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Tokyo, Japan
| | - Kouhei Ishikawa
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Tokyo, Japan
| | - Youichi Yanagawa
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Tokyo, Japan
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13
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Hosomi S, Kitamura T, Sobue T, Nakagawa Y, Ogura H, Shimazu T. Association of Pre-Hospital Helicopter Transport with Reduced Mortality in Traumatic Brain Injury in Japan: A Nationwide Retrospective Cohort Study. J Neurotrauma 2021; 39:76-85. [PMID: 34779275 PMCID: PMC8785714 DOI: 10.1089/neu.2021.0181] [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: 11/13/2022] Open
Abstract
Patients with traumatic brain injury (TBI) are severely injured patients who require timely, efficient, and specialized care. The effectiveness of helicopter emergency medical services (HEMS) for patients with TBI remains unclear. This study aimed to compare the mortality of patients with TBI transported by HEMS and ground ambulance using propensity score-matching analysis, and to analyze the effects of HEMS in various subpopulations. We conducted a retrospective analysis of the Japan Trauma Data Bank. The study period was from January 2004 to December 2018. The participants were divided into two groups: the helicopter group (patients transported by HEMS) and ground group (patients transported by ground ambulance). The principal outcome was death at hospital discharge. In total, 58,532 patients were eligible for analysis (ground group, n = 54,820 [93.7%]; helicopter group, n = 3712 [6.3%]). Helicopter transport decreased patient mortality at hospital discharge (adjusted odds ratio [OR], 0.83; 95% confidence interval [CI], 0.74-0.92). In propensity score-matched patients, the proportion of deaths at hospital discharge was lower in the helicopter (18.76%) than in the ground (21.21%) group (crude OR, 0.86; 95% CI, 0.77-0.96). The mortality rate in the helicopter group was significantly reduced in many subpopulations, especially in cases of severe TBI with a decreased level of consciousness or higher Injury Severity Score (ISS; Japan Coma Scale score 2 [adjusted OR, 0.60; 95% CI, 0.45-0.80] and ISS ≥50 [adjusted OR, 0.69; 95% CI, 0.48-0.99]). Although the study design was non-randomized, our findings in patients with TBI showed that HEMS conferred a mortality benefit over ground ambulance.
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Affiliation(s)
- Sanae Hosomi
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.,Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Tetsuhisa Kitamura
- Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Tomotaka Sobue
- Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yuko Nakagawa
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hiroshi Ogura
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Takeshi Shimazu
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
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14
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Ono Y, Iwasaki Y, Hirano T, Hashimoto K, Kakamu T, Inoue S, Kotani J, Shinohara K. Impact of emergency physician-staffed ambulances on preoperative time course and survival among injured patients requiring emergency surgery or transarterial embolization: A retrospective cohort study at a community emergency department in Japan. PLoS One 2021; 16:e0259733. [PMID: 34748604 PMCID: PMC8575187 DOI: 10.1371/journal.pone.0259733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 10/25/2021] [Indexed: 11/18/2022] Open
Abstract
Injured patients requiring definitive intervention, such as surgery or transarterial embolization (TAE), are an extremely time-sensitive population. The effect of an emergency physician (EP) patient care delivery system in this important trauma subset remains unclear. We aimed to clarify whether the preoperative time course and mortality among injured patients differ between ambulances staffed by EPs and those staffed by emergency life-saving technicians (ELST). This was a retrospective cohort study at a community emergency department (ED) in Japan. We included all injured patients requiring emergency surgery or TAE who were transported directly from the ED to the operating room from January 2002 to December 2019. The primary exposure was dispatch of an EP-staffed ambulance to the prehospital scene. The primary outcome measures were preoperative time course including prehospital length of stay (LOS), ED LOS, and total time to definitive intervention. The other outcome of interest was in-hospital mortality. One-to-one propensity score matching was performed to compare these outcomes between the groups. Of the 1,020 eligible patients, 353 (34.6%) were transported to the ED by an EP-staffed ambulance. In the propensity score-matched analysis with 295 pairs, the EP group showed a significant increase in median prehospital LOS (71.0 min vs. 41.0 min, P < 0.001) and total time to definitive intervention (189.0 min vs. 177.0 min, P = 0.002) in comparison with the ELST group. Conversely, ED LOS was significantly shorter in the EP group than in the ELST group (120.0 min vs. 131.0 min, P = 0.043). There was no significant difference in mortality between the two groups (8.8% vs.9.8%, P = 0.671). At a community hospital in Japan, EP-staffed ambulances were found to be associated with prolonged prehospital time, delay in definitive treatment, and did not improve survival among injured patients needing definitive hemostatic procedures compared with ELST-staffed ambulances.
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Affiliation(s)
- Yuko Ono
- Department of Disaster and Emergency Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan
- Department of Anesthesiology, Ohta General Hospital Foundation, Ohta Nishinouchi Hospital, Koriyama, Japan
| | - Yudai Iwasaki
- Department of Anesthesiology, Ohta General Hospital Foundation, Ohta Nishinouchi Hospital, Koriyama, Japan
- Department of Anesthesiology and Perioperative Medicine, Tohoku University, Graduate School of Medicine, Sendai, Japan
| | - Takaki Hirano
- Department of Anesthesiology, Ohta General Hospital Foundation, Ohta Nishinouchi Hospital, Koriyama, Japan
| | - Katsuhiko Hashimoto
- Department of Anesthesiology, Ohta General Hospital Foundation, Ohta Nishinouchi Hospital, Koriyama, Japan
- Department of Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, Fukushima, Japan
| | - Takeyasu Kakamu
- Department of Hygiene and Preventive Medicine, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Shigeaki Inoue
- Department of Disaster and Emergency Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Joji Kotani
- Department of Disaster and Emergency Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Kazuaki Shinohara
- Department of Anesthesiology, Ohta General Hospital Foundation, Ohta Nishinouchi Hospital, Koriyama, Japan
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15
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Ota S, Jitsuiki K, Muramatsu KI, Kushida Y, Nagasawa H, Ohsaka H, Omori K, Yanagawa Y. The utility of physician-staffed helicopters for managing individuals who experience severe isolated head trauma. J Rural Med 2021; 16:245-249. [PMID: 34707734 PMCID: PMC8527619 DOI: 10.2185/jrm.2021-016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 06/28/2021] [Indexed: 11/27/2022] Open
Abstract
Objective: The authors retrospectively investigated prognostic factors for
severe isolated head trauma in patients evacuated by a physician-staffed helicopter
emergency medical service (HEMS) or ground ambulance using data from the Japan Trauma Data
Bank (JTDB). Patients and Methods: This study was a retrospective analysis of data housed
in the JTDB database. The study period was from January 2004 to May 2019. Subjects were
divided into two groups according to the method of transportation: helicopter (i.e.,
HEMS), which included patients transported by a physician-staffed helicopter; and
ambulance, which included patients transported by ground ambulance. Results: A total of 41,358 patients were enrolled in the study, including
2,029 in the helicopter group and 39,329 in the ambulance group. The ratio of males,
median head Abbreviated Injury Scale and Injury Severity Scale (ISS) scores were
significantly greater in the helicopter group than in the ambulance group, while the
average age, median Glasgow Coma Scale, average Revised Trauma Score (RTS), and survival
rate were significantly lower in the helicopter group than in the ambulance group. Of the
variables that demonstrated statistical significance in the univariate analysis and
classification of transportation and included in the multivariate analysis, the following
were identified as significant predictors of survival outcomes: younger age, lower ISS,
female sex, and greater RTS. HEMS was not a significant predictor of survival. Conclusion: The present study revealed no effect of HEMS transport on the
outcomes of patients who experienced severe isolated head trauma compared with ground
ambulance transportation. Further prospective studies, including an analysis of the
operation time or distance traveled by the HEMS and the functional outcome(s) of patients
with severe head injury transported by HEMS, are warranted.
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Affiliation(s)
- Soichiro Ota
- Department of Acute Critical Care Medicine, Juntendo University Shizuoka Hospital, Japan
| | - Kei Jitsuiki
- Department of Acute Critical Care Medicine, Juntendo University Shizuoka Hospital, Japan
| | - Ken-Ichi Muramatsu
- Department of Acute Critical Care Medicine, Juntendo University Shizuoka Hospital, Japan
| | - Yoshihiro Kushida
- Department of Acute Critical Care Medicine, Juntendo University Shizuoka Hospital, Japan
| | - Hiroki Nagasawa
- Department of Acute Critical Care Medicine, Juntendo University Shizuoka Hospital, Japan
| | - Hiromichi Ohsaka
- Department of Acute Critical Care Medicine, Juntendo University Shizuoka Hospital, Japan
| | - Kazuhiko Omori
- Department of Acute Critical Care Medicine, Juntendo University Shizuoka Hospital, Japan
| | - Youichi Yanagawa
- Department of Acute Critical Care Medicine, Juntendo University Shizuoka Hospital, Japan
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16
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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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17
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Ishiyama M, Kurita T, Takasaki A, Takamura T, Masuda J, Ishikura K, Seko T, Setsuda M, Kasai A, Imai H, Dohi K. Impact of Helicopter Transport on Reperfusion Times and Long-Term Outcomes in Acute Myocardial Infarction Patients in Rural Areas: A Report From the Mie Acute Coronary Syndrome Registry. Air Med J 2021; 40:337-343. [PMID: 34535242 DOI: 10.1016/j.amj.2021.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 04/14/2021] [Accepted: 05/03/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Helicopter emergency medical services (HEMS) are effective for time-sensitive conditions, such as stroke and trauma. However, prognostic data on helicopter transport for acute myocardial infarction (AMI) patients are insufficient. METHODS We registered 2,681 AMI patients in the Mie Acute Coronary Syndrome Registry and enrolled 163 patients from rural areas to HEMS base hospitals with HEMS or ground emergency medical services (GEMS). They were categorized into 4 groups according to the transportation method for interhospital transfer (direct HEMS: n = 52, direct GEMS: n = 54, interhospital HEMS: n = 32, and interhospital GEMS: n = 25). The primary end point was the emergency medical services (EMS) call-to-balloon time. The secondary end point was 2-year major adverse cardiac and cerebrovascular events. RESULTS The direct HEMS group was younger than the direct GEMS group (P = .029). The EMS call-to-balloon time was shorter in the direct HEMS and interhospital HEMS groups than in each GEMS group (P = .015 and P = .046). The incidence of 2-year major adverse cardiac and cerebrovascular events tended to be lower in both HEMS groups than in each GEMS group. CONCLUSION Direct HEMS for AMI in rural areas shortens the time from the EMS call to reperfusion when the transport distance is expected to exceed 30 km, which may result in a better patient prognosis. In addition, prehospital diagnostic modalities, such as 12-lead electrocardiography and echocardiography, may shorten the duration from the EMS call to reperfusion.
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Affiliation(s)
- Masaki Ishiyama
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Tairo Kurita
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Mie, Japan.
| | - Akihiro Takasaki
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Takeshi Takamura
- Department of Cardiology, Ise Red Cross Hospital, Ise, Mie, Japan
| | - Jun Masuda
- Department of Cardiology, Mie Prefectural General Medical Center, Yokkaichi, Mie, Japan
| | - Ken Ishikura
- Emergency Critical Care Center, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Tetsuya Seko
- Department of Cardiology, Ise Red Cross Hospital, Ise, Mie, Japan
| | - Morimichi Setsuda
- Emergency and Critical Care Center, Ise Red Cross Hospital, Ise, Mie, Japan
| | - Atsunobu Kasai
- Department of Cardiology, Ise Red Cross Hospital, Ise, Mie, Japan
| | - Hiroshi Imai
- Emergency Critical Care Center, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Kaoru Dohi
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Mie, Japan
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18
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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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19
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Bitencourt MR, Iora P, Dutra ADC, Bitencourt MR, Franco RDL, Fontes CER, Carvalho MDDB, Joiner A, Vissoci JRN, Staton C, de Andrade L. Helicopter Transportation of Brazilian Trauma Patients: A Comparison of Times to Care. Air Med J 2021; 40:259-263. [PMID: 34172234 DOI: 10.1016/j.amj.2021.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 03/02/2021] [Accepted: 03/10/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The purpose of this study was to analyze helicopter emergency medical service (HEMS) transport with secondary land ambulance transfer, comparing landings performed inside and outside the hospital complex to the emergency department. METHODS This was a cross-sectional observational study of HEMS transports of trauma patients between 2016 and 2018 in southern Brazil. Patients were attended by the HEMS team at the trauma site or stabilized in hospitals nearby and subsequently referred to trauma centers. In this region, no trauma centers have their own helipads so helicopters land in remote areas close to the hospital, which may be inside or outside the hospital complex. Both landings require ground emergency medical service transport, with off-site landings necessitating ground emergency medical service transport via public access roads to reach the hospital. Data were analyzed using descriptive statistics, and on-site and off-site transport times were compared using a t-test for independent samples. RESULTS Of 176 transports, 28.5% resulted in on-site landings, whereas 71.5% occurred off-site. The ground transport time when the landing zone was off-site was 5 minutes longer than on-site (P < .001). CONCLUSION Off-site landings result in longer transports to the emergency room. The construction of helipads in trauma centers can reduce transport time, in addition to reducing the costs and sequelae of trauma.
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Affiliation(s)
| | - Pedro Iora
- Department of Medicine, State University of Maringa, Maringá, Paraná, Brazil
| | | | | | - Rogério do Lago Franco
- Department of Health Sciences, State University of Maringa, Maringá, Paraná, Brazil; Department of Medicine, State University of Maringa, Maringá, Paraná, Brazil
| | | | | | - Anjni Joiner
- Division of Emergency Medicine, Department of Surgery, Duke Global Health Institute, Duke University, Durham, NC
| | - João Ricardo Nickenig Vissoci
- Department of Medicine, State University of Maringa, Maringá, Paraná, Brazil; Division of Emergency Medicine, Department of Surgery, Duke Global Health Institute, Duke University, Durham, NC
| | - Catherine Staton
- Division of Emergency Medicine, Department of Surgery, Duke Global Health Institute, Duke University, Durham, NC
| | - Luciano de Andrade
- Department of Health Sciences, State University of Maringa, Maringá, Paraná, Brazil; Department of Medicine, State University of Maringa, Maringá, Paraná, Brazil
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Nabeta M, Murotani K, Kannae M, Tashiro K, Hirayu N, Morita T, Uzu H, Takasu O. Comparison of physician-staffed helicopter with ground-based emergency medical services for trauma patients. Am J Emerg Med 2021; 45:75-79. [PMID: 33676079 DOI: 10.1016/j.ajem.2021.02.062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 02/20/2021] [Accepted: 02/25/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Few studies have discussed whether physician-staffed helicopter emergency medical services (HEMS) provide temporal and geographical benefits for patients in remote locations compared to ground emergency medical services (GEMS). Our study seeks to clarify the significance of HEMS for patients with severe trauma by comparing the mortality of patients transported directly from crash scenes by HEMS or GEMS, taking geographical factors into account. METHODS Using medical records from a single center, collected from January 2014 to December 2018, we retrospectively identified 1674 trauma patients. Using propensity score analysis, we selected adult patients with an injury severity score ≥16, divided them into groups depending on their transport to the hospital by HEMS or GEMS, and compared their mortality within 24 h of hospitalization. For propensity score-matched groups, we analyzed distance and time. RESULTS Of the 317 eligible patients, 202 were transported by HEMS. In the propensity score matching analysis, there was no significant difference in mortality between the HEMS and GEMS groups: 8.7% vs. 5.8%, odds ratio (OR), 1.547 (95% confidence interval [CI], 0.530-4.514). The inverse probability of treatment weighting (IPTW): 11% vs. 7.8%, OR, 1.080 (95% CI, 0.640-1.823); stabilized IPTW: 11% vs. 7.8%, OR, 1.080 (95% CI, 0.502-2.324); and truncated IPTW: 10% vs. 6.4%, OR, 1.143 (95% CI, 0.654-1.997). The distance from the crash scene to the hospital was farther in the HEMS group, and it took a longer period of time to arrive at the hospital (P < 0.001). CONCLUSIONS HEMS may provide equal treatment opportunities and minimize trauma deaths for patients transported from a greater distance to an emergency medical center compared to GEMS for patients transported from nearby regions.
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Affiliation(s)
- Masakazu Nabeta
- Department of Emergency and Critical Care Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, Japan.
| | - Kenta Murotani
- Biostatistics Center, Graduate School of Medicine, Kurume University, 67 Asahi-machi, Kurume, Fukuoka, Japan
| | - Mikinori Kannae
- Department of Emergency and Critical Care Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, Japan
| | - Keita Tashiro
- Department of Emergency and Critical Care Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, Japan
| | - Nobuhisa Hirayu
- Department of Emergency and Critical Care Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, Japan
| | - Toshio Morita
- Department of Emergency and Critical Care Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, Japan
| | - Hideaki Uzu
- Department of Emergency and Critical Care Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, Japan
| | - Osamu Takasu
- Department of Emergency and Critical Care Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, Japan
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Sun H, Liu J, Han Z, Jiang J. Stochastic Petri Net Based Modeling of Emergency Medical Rescue Processes during Earthquakes. JOURNAL OF SYSTEMS SCIENCE AND COMPLEXITY 2021; 34:1063-1086. [PMID: 33456273 PMCID: PMC7801775 DOI: 10.1007/s11424-020-9139-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 02/22/2020] [Indexed: 06/12/2023]
Abstract
The post-disaster emergency medical rescue (EMR) is critical for people's lives. This paper presents a stochastic Petri net (SPN) model based on the process of the rescue structure and a Markov chain model (MC), which is applied to the optimization of the EMR process, with the aim of identifying the key activities of EMR. An isomorphic MC model is developed for measuring and evaluating the time performance of the EMR process during earthquakes with the data of the 2008 Wenchuan earthquake. This paper provides a mathematical approach to simulate the process and to evaluate the efficiency of EMR. Simultaneously, the expressions of the steady state probabilities of this system under various states are obtained based on the MC, and the variations of the probabilities are analyzed by changing the firing rates for every transition. Based on the concrete data of the event, the authors find the most time consuming and critical activities for EMR decisions. The model results show that the key activities can improve the efficiency of medical rescue, providing decision-makers with rescue strategies during the large scale earthquake.
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Affiliation(s)
- Huali Sun
- School of Management, Shanghai University, Shanghai, 200444 China
| | - Jiaguo Liu
- School of Maritime Economics and Management, Dalian Maritime University, Dalian, 116026 China
| | - Ziqiang Han
- School of Political Science and Public Administration, Shandong University, Qingdao, 266237 China
| | - Juan Jiang
- School of Management, Shanghai University, Shanghai, 200444 China
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Comparative Study on the Outcome of Stroke Patients Transferred by Doctor Helicopters and Ground Ambulances in South Korea: A Retrospective Controlled Study. Emerg Med Int 2020; 2020:8493289. [PMID: 33224530 PMCID: PMC7670300 DOI: 10.1155/2020/8493289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 08/22/2020] [Accepted: 09/27/2020] [Indexed: 11/24/2022] Open
Abstract
The purpose of this study was to analyze the effectiveness of helicopter emergency medical services (HEMS) for its economic operations in South Korea. This study targeted stroke patients who were transported via HEMS or ground emergency medical services (GEMS) from the scene of an accident to a regional emergency medical center. From this patient population, stroke patients who traveled at least 50 km from the scene of the cerebral infarction to the hospital with analyzable outcome data were extracted and included in this study. This study included 26 HEMS and 102 GEMS stroke patients from a pool of 183 potential patients. The survival-to-discharge rate of patients transported via HEMS (96.2%; 25/26) was significantly higher than that of patients transported via GEMS (83.2%; 104/128) (P=0.001). The HEMS transfer was quicker with respect to the decision-making process because the emergency physician actively evaluates and communicates on-site and during in-transit travel to request an appointment immediately upon arrival at the emergency room. These results indicate that using HEMS increased discharge and survival rates and reduced in-hospital mortality of HEMS of stroke patients with a reduced admission time. This result association leads to reasonable cost-effectiveness and efficient estimates overall. In conclusion, HEMS indicate reduced time taken for stroke patients to be hospitalized and treated and decreased mortality after 24 hours. According to this result, HEMS transport can be more effective than GEMS in long-distance delivery of stroke patients.
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Nasser AAH, Khouli Y. The Impact of Prehospital Transport Mode on Mortality of Penetrating Trauma Patients. Air Med J 2020; 39:502-505. [PMID: 33228903 DOI: 10.1016/j.amj.2020.07.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 06/10/2020] [Accepted: 07/21/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE The optimal mode of transport of trauma patients from the scene to the hospital remains unknown. We aimed to study the impact of different prehospital modes of transport of penetrating trauma patients on hospital mortality. METHODS Using the Trauma Quality Improvement Program 2010 to 2016 database, we identified all adults with a penetrating injury. Univariate then multivariable logistic regression analyses were performed to study the correlation between the mode of transport and in-hospital mortality, adjusting for several covariates. RESULTS A total of 92,427 subjects were included. The overall mean transport time for patients transported by a ground ambulance, helicopter, fixed wing ambulance, and police/private vehicle were 32.2, 61.2, 68.9, and 28.2 minutes, respectively. Multivariable analyses revealed that compared with ground ambulance, helicopter transport was associated with a 34% decrease in the odds of mortality (odds ratio = 0.66, P < .0001), whereas police transport and private vehicle transport were associated with a 52% decrease in the odds of mortality (odds ratio = 0.48, P < .0001). CONCLUSION Helicopter, police, and private vehicle transports are associated with a decreased odds of mortality compared with ground ambulance. Further research should examine the variation in levels of care within different modes of prehospital transport.
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Affiliation(s)
- Ahmed A H Nasser
- Trauma and Orthopaedics Department, West Middlesex University Hospital, Chelsea and Westminster NHS Foundation Trust, Isleworth, United Kingdom.
| | - Yousef Khouli
- General Surgery Department, Broomfield Hospital, Mid Essex Hospitals NHS Trust, Broomfield, United Kingdom
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Stassen W, Alkzair S, Kurland L. Helicopter Emergency Medical Services in Trauma Does Not Influence Mortality in South Africa. Air Med J 2020; 39:479-483. [PMID: 33228898 DOI: 10.1016/j.amj.2020.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 06/19/2020] [Accepted: 08/02/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Sub-Saharan Africa carries a large trauma burden. Helicopter emergency medical services (HEMS) have been suggested to reduce prehospital time and mortality. It is not clear whether HEMS infers a mortality benefit over ground transport in South Africa. This study aimed to determine whether HEMS improved 30-day mortality over ground emergency medical services (GEMS). METHODS A retrospective, case-control study was undertaken for major trauma patients transported to a private trauma center in Johannesburg. A 1-year cohort of HEMS patients was extracted and matched to GEMS patients based on mechanism, injury severity or percentage of the total body surface area burned, age, sex, and comorbidities. The odds ratio (OR) for 30-day mortality was calculated to determine the risk of death. RESULTS A total of 822 cases (HEMS: 272 [33%], GEMS: 550 [67%]) were reviewed. We included 410 patients in the matched cohort with equal distribution between transportation modes. The OR for mortality in the total cohort was 2.69 (95% confidence interval, 1.6-4.6; P = .003) for HEMS patients, whereas in the matched cohort the OR was 1.35 (95% confidence interval, 0.5-3.4; P = .503) for patients transported by HEMS. CONCLUSION In a matched cohort of major trauma patients, HEMS does not seem to improve mortality over GEMS. These results might reflect the South African HEMS dispatch model.
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Affiliation(s)
- Willem Stassen
- Division of Emergency Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
| | | | - Lisa Kurland
- School of Medical Sciences, Ӧrebro University, Ӧrebro, Sweden
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Yanagawa Y, Jitsuiki K, Muramatsu KI, Ikegami S, Kushida Y, Nagasawa H, Nishio R, Takeuchi I, Ohsaka H, Oode Y, Omori K. Survey of trauma patients injured by falling or flying objects in Japan based on the Japan Trauma Data Bank. Eur J Trauma Emerg Surg 2020; 48:667-677. [PMID: 33026458 DOI: 10.1007/s00068-020-01519-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 09/26/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE We retrospectively investigated patients injured by falling/flying objects using the Japan Trauma Data Bank (JTDB). METHODS The study collected information of the JTEB from January 2004 to May 2019. The subjects were divided into two groups: the unexpected accident (UA) group included cases in which the patient was injured by an unexpected accident; the labor accident (LA) group included cases in which the patient was injured at work. RESULTS A total of 1997 patients were enrolled as subjects (UA group, n = 383; LA group, n = 1134). In both groups, head injuries were the most frequent type of injury, followed by chest injuries. The median head abbreviated injury scale of the UA group was significantly higher than that of the LA group. In the UA group, the percentage of female patients, average age, and average TRISS value were significantly greater in comparison to the LA group. The frequency of emergency operations in the UA group was significantly lower in comparison to the LA group. The frequency of head injuries in the UA group was significantly greater than that in the LA group. The frequencies of upper extremity and lower extremity injuries in the UA group were significantly lower than those in the LA group. CONCLUSION This is the first report to analyze trauma patients injured by falling/flying objects using the JTDB. Public health and emergency providers can use this information to anticipate the health-care needs after falling/flying object injuries.
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Affiliation(s)
- Youichi Yanagawa
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, 1129 Nagaoka, Izunokuni City, Shizuoka, 410-2295, Japan.
| | - Kei Jitsuiki
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, 1129 Nagaoka, Izunokuni City, Shizuoka, 410-2295, Japan
| | - Ken-Ichi Muramatsu
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, 1129 Nagaoka, Izunokuni City, Shizuoka, 410-2295, Japan
| | - Saya Ikegami
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, 1129 Nagaoka, Izunokuni City, Shizuoka, 410-2295, Japan
| | - Yoshihiro Kushida
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, 1129 Nagaoka, Izunokuni City, Shizuoka, 410-2295, Japan
| | - Hiroki Nagasawa
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, 1129 Nagaoka, Izunokuni City, Shizuoka, 410-2295, Japan
| | - Ryoto Nishio
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, 1129 Nagaoka, Izunokuni City, Shizuoka, 410-2295, Japan
| | - Ikuto Takeuchi
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, 1129 Nagaoka, Izunokuni City, Shizuoka, 410-2295, Japan
| | - Hiromichi Ohsaka
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, 1129 Nagaoka, Izunokuni City, Shizuoka, 410-2295, Japan
| | - Yasumasa Oode
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, 1129 Nagaoka, Izunokuni City, Shizuoka, 410-2295, Japan
| | - Kazuhiko Omori
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, 1129 Nagaoka, Izunokuni City, Shizuoka, 410-2295, Japan
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Kushida Y, Jitsuiki K, Muramatsu KI, Ikegami S, Nagasawa H, Takeuchi I, Ohsaka H, Oode Y, Omori K, Yanagawa Y. A comparison of physician-staffed helicopters and ground ambulances transport for the outcome of severe thoracic trauma patients. Am J Emerg Med 2020; 45:358-360. [PMID: 33039240 DOI: 10.1016/j.ajem.2020.08.088] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 08/22/2020] [Accepted: 08/27/2020] [Indexed: 11/28/2022] Open
Abstract
PURPOSE We retrospectively investigated prognostic factors for severe thoracic trauma patients evacuated by a physician-staffed helicopter emergency medical service (HEMS) and ground ambulance using the Japan Trauma Data Bank (JTDB). METHODS This study was a retrospective analysis of the JTDB database. The study period was from January 2004 to May 2019. The subjects were divided into two groups, according to the type of transportation: the Heli group included cases transported by the HEMS, while the Ambulance group included cases transported by ground ambulance. RESULTS During the investigation period, a total of 57,872 patients were enrolled as subjects, including 7238 in the Heli group and 50,634 in the Ambulance group. The average age, male ratio, average injury severity score (ISS), average revised trauma score (RTS) and survival ratio were significantly greater in the Heli group than in the Ambulance group. After performing a propensity score-matched analysis, there were no statistical differences concerning the age, sex, ISS, RTS between the two groups. However, the survival ratio in the Heli group remained greater than that in the Ambulance group. When variables that showed statistical significance in the univariate analysis were included in a multivariate analysis, the RTS, transport by the HEMS, age, ISS and female gender were identified as significant predictors of a survival outcome. The HEMS was significantly associated with an increased survival ratio (odds ratio: 1.69; 95% confidence interval: 1.51-1.88) compared with a ground ambulance. CONCLUSION The present study showed that transport by the HEMS improved the survival rate compared to that by a ground ambulance for patients with severe thoracic trauma.
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Affiliation(s)
- Yoshihiro Kushida
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, 410-2295, Japan
| | - Kei Jitsuiki
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, 410-2295, Japan
| | - Ken-Ichi Muramatsu
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, 410-2295, Japan
| | - Saya Ikegami
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, 410-2295, Japan
| | - Hiroki Nagasawa
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, 410-2295, Japan
| | - Ikuto Takeuchi
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, 410-2295, Japan
| | - Hiromichi Ohsaka
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, 410-2295, Japan
| | - Yasumasa Oode
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, 410-2295, Japan
| | - Kazuhiko Omori
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, 410-2295, Japan
| | - Youichi Yanagawa
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, 410-2295, Japan.
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Yanagawa Y, Jitsuiki K, Muramatsu KI, Kushida Y, Ikegami S, Nagasawa H, Takeuchi I, Ohsaka H, Omori K, Oode Y. Clinical Investigation of Burn Patients Transported by Helicopter Based on the Japan Trauma Data Bank. Air Med J 2020; 39:464-467. [PMID: 33228895 DOI: 10.1016/j.amj.2020.08.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 07/29/2020] [Accepted: 08/20/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We retrospectively investigated the actual conditions of burn patients evacuated by helicopter in comparison to those evacuated by ground ambulance using the Japan Trauma Data Bank. METHODS This study was a retrospective analysis of the data recorded in the Japan Trauma Data Bank between January 2004 and May 2019. After propensity score matching for the method of transportation, the survival rate was compared between the 2 groups. RESULTS During the investigation period, there were 4,627 burn patients (helicopter group, n = 276; ambulance group, n = 4,351). After propensity score matching, there were no significant differences between the 2 groups in any of the assessed variables, and the survival rate did not differ to a statistically significant extent. CONCLUSION After propensity score matching, the survival rate of the helicopter group did not appear to be superior to the ambulance group. Further prospective studies are needed to explore the proper indications for air transportation of burn patients, which could potentially improve outcomes.
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Affiliation(s)
- Youichi Yanagawa
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Shizuoka, Japan.
| | - Kei Jitsuiki
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Shizuoka, Japan
| | - Ken-Ichi Muramatsu
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Shizuoka, Japan
| | - Yoshihiro Kushida
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Shizuoka, Japan
| | - Saya Ikegami
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Shizuoka, Japan
| | - Hiroki Nagasawa
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Shizuoka, Japan
| | - Ikuto Takeuchi
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Shizuoka, Japan
| | - Hiromichi Ohsaka
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Shizuoka, Japan
| | - Kazuhiko Omori
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Shizuoka, Japan
| | - Yasumasa Oode
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Shizuoka, Japan
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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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Yanagawa Y, Omori K, Muramatsu KI, Kushida Y, Ikegami S, Nagasawa H, Nishio R, Takeuchi I, Jitsuiki K, Ohsaka H, Oode Y. Prognostic Factors in Trauma Patients Transported by Physician-Staffed Helicopter in Japan: An Investigation Based on the Japan Trauma Data Bank. Air Med J 2020; 39:494-497. [PMID: 33228901 DOI: 10.1016/j.amj.2020.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 06/23/2020] [Accepted: 07/23/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE We retrospectively investigated prognostic factors for patients evacuated by the physician-staffed helicopter emergency medical service using the Japan Trauma Data Bank. METHODS The study period was from January 2004 to May 2019. The subjects were divided into 2 groups according to the outcome: the survival group and the fatal group. RESULTS A total of 19,370 patients were enrolled as subjects. There were 17,080 patients in the survival group and 2,290 in the fatal group. In a multivariate analysis of factors that showed statistical significance in a univariate analysis, the Revised Trauma Score, age, Injury Severity Score, Maximum Abbreviated Injury Scale (MAX-AIS) for the upper extremity (negative), year of helicopter dispatch, Japan Coma Scale, MAX-AIS for the head, MAX-AIS for the abdomen/pelvis, and MAX-AIS for the spine were identified as significant predictors of a fatal outcome . CONCLUSION This is the first report to investigate the prognostic factors of patients evacuated by helicopter emergency medical service using the Japan Trauma Data Bank. The results suggest that physiological abnormality, age, traumatic anatomic abnormality (other than upper extremity abnormality), and year of helicopter dispatch may be prognostic factors.
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Affiliation(s)
- Youichi Yanagawa
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Shizuoka, Japan..
| | - Kazuhiko Omori
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Shizuoka, Japan
| | - Ken-Ichi Muramatsu
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Shizuoka, Japan
| | - Yoshihiro Kushida
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Shizuoka, Japan
| | - Saya Ikegami
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Shizuoka, Japan
| | - Hiroki Nagasawa
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Shizuoka, Japan
| | - Ryota Nishio
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Shizuoka, Japan
| | - Ikuto Takeuchi
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Shizuoka, Japan
| | - Kei Jitsuiki
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Shizuoka, Japan
| | - Hiromichi Ohsaka
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Shizuoka, Japan
| | - Yasumasa Oode
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Shizuoka, Japan
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30
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Tønsager K, Krüger AJ, Ringdal KG, Rehn M. Data quality of Glasgow Coma Scale and Systolic Blood Pressure in scientific studies involving physician-staffed emergency medical services: Systematic review. Acta Anaesthesiol Scand 2020; 64:888-909. [PMID: 32270473 DOI: 10.1111/aas.13596] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 03/19/2020] [Accepted: 03/21/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Emergency physicians on-scene provide highly specialized care to severely sick or injured patients. High-quality research relies on the quality of data, but no commonly accepted definition of EMS data quality exits. Glasgow Coma Score (GCS) and Systolic Blood Pressure (SBP) are core physiological variables, but little is known about the quality of these data when reported in p-EMS research. This systematic review aims to describe the quality of pre-hospital reporting of GCS and SBP data in studies where emergency physicians are present on-scene. METHODS A systematic literature search was performed using CINAHL, Cochrane, Embase, Medline, Norart, Scopus, SweMed + and Web of Science, in accordance with the PRISMA guidelines. Reported data on accuracy of reporting, completeness and capture were extracted to describe the quality of documentation of GCS and SBP. External and internal validity assessment was performed by extracting a set of predefined variables. RESULTS We included 137 articles describing data collection for GCS, SBP or both. Most studies (81%) were conducted in Europe and 59% of studies reported trauma cases. Reporting of GCS and SBP data were not uniform and may be improved to enable comparisons. Of the predefined external and internal validity data items, 26%-45% of data were possible to extract from the included papers. CONCLUSIONS Reporting of GCS and SBP is variable in scientific papers. We recommend standardized reporting to enable comparisons of p-EMS.
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Affiliation(s)
- Kristin Tønsager
- Department of Research The Norwegian Air Ambulance Foundation Oslo Norway
- Department of Anaesthesiology and Intensive Care Stavanger University Hospital Stavanger Norway
- Faculty of Health Sciences University of Stavanger Stavanger Norway
| | - Andreas J. Krüger
- Department of Research The Norwegian Air Ambulance Foundation Oslo Norway
- Department of Emergency Medicine and Pre-Hospital Services St. Olavs Hospital Trondheim Norway
| | - Kjetil G. Ringdal
- Department of Anaesthesiology Vestfold Hospital Trust Tønsberg Norway
- Norwegian Trauma Registry Oslo University Hospital Oslo Norway
| | - Marius Rehn
- Department of Research The Norwegian Air Ambulance Foundation Oslo Norway
- Faculty of Health Sciences University of Stavanger Stavanger Norway
- Pre-hospital Division Air Ambulance DepartmentOslo University Hospital Oslo Norway
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Aoki M, Abe T, Hagiwara S, Saitoh D, Oshima K. Resuscitative endovascular balloon occlusion of the aorta may contribute to improved survival. Scand J Trauma Resusc Emerg Med 2020; 28:62. [PMID: 32605626 PMCID: PMC7325257 DOI: 10.1186/s13049-020-00757-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 06/24/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an increasingly used trauma resuscitation procedure, however, there are no reports of whether or not the survival of patients treated with REBOA increases over time. METHODS This retrospective cohort study from a nationwide trauma registry in Japan was conducted between 2004 and 2015. Patients treated with REBOA were divided into three calendar year periods: early-period (2004-2007), mid-period (2008-2011), and late-period (2012-2015). The primary outcome of in-hospital survival was compared between the periods (early-period: reference) using mixed effects logistic regression analysis after adjustment for characteristics, trauma severity, and therapeutic choices. RESULTS Of 236,698 trauma patients, 633 patients treated with REBOA were analyzed. Distribution of the patients across periods was as follows: early-period (91), mid-period (276), and late-period (266). In-hospital survival was 39, 49, and 60% in the early-period, mid-period, and late-period, respectively. In regression modeling, the late-period (OR = 2.976, 95% CI = 1.615-5.482) was associated with improved in-hospital survival compared to the early-period, however, the mid-period (OR = 1.614, 95% CI = 0.898-2.904) was not associated with improved survival. CONCLUSIONS Survival of patients treated with REBOA during the late-period improved compared with survival during the early-period, after adjustment for characteristics, trauma severity, and therapeutic choices. REBOA may be one of the important factors related to progression of modern trauma treatment.
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Affiliation(s)
- Makoto Aoki
- Department of Emergency Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan.
| | - Toshikazu Abe
- Department of General Medicine, Juntendo University, Tokyo, Japan.,Health Services Research and Development Center, University of Tsukuba, Tsukuba, Japan
| | - Shuichi Hagiwara
- Department of Emergency Medicine, National Hospital Organization Takasaki General Medical Center, Takasaki, Japan
| | - Daizoh Saitoh
- Department of Traumatology and Emergency Medicine, National Defense Medical College, Tokorozawa, Japan
| | - Kiyohiro Oshima
- Department of Emergency Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
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Miyamoto K, Shibata N, Ogawa A, Nakashima T, Kato S. Prehospital and in-hospital quick Sequential Organ Failure Assessment (qSOFA) scores to predict in-hospital mortality among trauma patients: an analysis of nationwide registry data. Acute Med Surg 2020; 7:e532. [PMID: 32587706 PMCID: PMC7311801 DOI: 10.1002/ams2.532] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 04/30/2020] [Accepted: 05/22/2020] [Indexed: 01/31/2023] Open
Abstract
Aim The quick Sequential Organ Failure Assessment (qSOFA) score can be used to predict in‐hospital mortality in trauma patients. We sought to determine whether repeatedly calculating the qSOFA score improves its discriminative ability in predicting in‐hospital mortality in trauma patients. Methods We undertook a multicenter retrospective study, analyzing 90,974 trauma patients registered in the Japan Trauma Data Bank (a nationwide trauma registry) from 2004 to 2017. Patients included were ≥18 years old and transferred directly to hospitals from their respective scenes of injury. We calculated the qSOFA score at two time points: at the scene (prehospital qSOFA score) and on arrival at the hospital (hospital qSOFA score). We evaluated the discriminative ability of repeated calculations of the qSOFA score. The primary outcome in consideration was in‐hospital mortality. Results In‐hospital mortality occurred in 5604 patients (6.2%). The predictive accuracy of the hospital qSOFA score was higher than that of the prehospital qSOFA (area under the receiver operating characteristics curve [AUROC] 0.74 vs. 0.69, P < 0.0001) in predicting in‐hospital mortality. However, the mean qSOFA score had the highest predictive accuracy (AUROC 0.76, P < 0.0001). If the hospital qSOFA score was increased compared to the prehospital score, this indicated an approximately 2‐fold to 4‐fold increase in in‐hospital mortality. Conclusions Repeated calculations of qSOFA score improved its ability to predict in‐hospital mortality in trauma patients. Specifically, we should consider an increasing qSOFA score as a “red flag” to clinicians in the emergency department.
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Affiliation(s)
- Kyohei Miyamoto
- Department of Emergency and Critical Care Medicine Wakayama Medical University Wakayama Japan
| | - Naoaki Shibata
- Department of Emergency and Critical Care Medicine Wakayama Medical University Wakayama Japan
| | - Atsuhiro Ogawa
- Department of Emergency and Critical Care Medicine Wakayama Medical University Wakayama Japan
| | - Tsuyoshi Nakashima
- Department of Emergency and Critical Care Medicine Wakayama Medical University Wakayama Japan
| | - Seiya Kato
- Department of Emergency and Critical Care Medicine Wakayama Medical University Wakayama Japan
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Kamata K, Abe T, Aoki M, Deshpande G, Saitoh D, Tokuda Y. Dynamic vital signs may predict in-hospital mortality in elderly trauma patients. Medicine (Baltimore) 2020; 99:e20741. [PMID: 32569217 PMCID: PMC7310890 DOI: 10.1097/md.0000000000020741] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Vital signs (VS) are dynamic parameters and understanding the significance of changes in VS in the acute setting may offer clinical meaning. We aimed to measure dynamic changes in vital signs (ΔVS) between site of trauma and presentation to hospital and investigate the association between ΔVS and in-hospital mortality among elderly with trauma.We conducted a retrospective cohort study between 2004 and 2015 using data from the nationwide trauma registry. Patients aged ≥75 years were included. Data were collected at scene of trauma and at arrival of emergency department (ED) in Japan with blunt or penetrating trauma. ΔVS scoring was defined based on clinical implications and previous reports. One point was given for each of the following criteria: systolic blood pressure reduction (-ΔSBP) of ≥30 mm Hg, heart rate increase (ΔHR) of ≥20/minute, and respiratory rate increase (ΔRR) of ≥10/minute between site of trauma and ED. The primary outcome was in-hospital mortality.Of 236,698 patients in the registry, data from 28,860 eligible patients (12.2%) were analyzed [mean age (SD), 83.2 (0.3); males, 57%]. Overall in-hospital mortality rate was 10.0%. In-hospital mortality increased from 9.0% to 16.5% for -ΔSBP; 9.2% to 22.2% for ΔHR; and 9.7% to 15.9% for ΔRR. ΔVS scores of 0, 1, 2, and 3 points were associated with in-hospital mortality of 8.2%, 14.9%, 30.1%, and 50.0%, respectively.A score based on the dynamic changes of VS, ΔVS score, may be helpful in predicting in-hospital mortality among elderly with trauma.
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Affiliation(s)
- Kazuhiro Kamata
- Emerging and Re-Emerging Infectious Diseases Unit, National Institute for Infectious Diseases “Lazzaro Spallanzani”, Rome, Italy
| | - Toshikazu Abe
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba
- Department of Emergency and Critical Care Medicine, Tsukuba Memorial Hospital, Tsukuba
| | - Makoto Aoki
- Department of Emergency Medicine, Gunma University Graduate School of Medicine, Maebashi
| | | | - Daizoh Saitoh
- Department of Traumatology and Emergency Medicine, National Defense Medical College, Tokorozawa
| | - Yasuharu Tokuda
- Department of Medicine, Muribushi Project for Okinawa Residency Programs, Urasoe, Japan
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Influence of prehospital physician presence on survival after severe trauma: Systematic review and meta-analysis. J Trauma Acute Care Surg 2020; 87:978-989. [PMID: 31335754 DOI: 10.1097/ta.0000000000002444] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND As trauma is one of the leading causes of death worldwide, there is great potential for reducing mortality in trauma patients. However, there is continuing controversy over the benefit of deploying emergency medical systems (EMS) physicians in the prehospital setting. The objective of this systematic review and meta-analysis is to assess how out-of-hospital hospital management of severely injured patients by EMS teams with and without physicians affects mortality. METHODS PubMed and Google Scholar were searched for relevant articles, and the search was supplemented by a hand search. Injury severity in the group of patients treated by an EMS team including a physician had to be comparable to the group treated without a physician. Primary outcome parameter was mortality. Helicopter transport as a confounder was accounted for by subgroup analyses including only the studies with comparable modes of transport. Quality of all included studies was assessed according to the Cochrane handbook. RESULTS There were 2,249 publications found, 71 full-text articles assessed, and 22 studies included. Nine of these studies were matched or adjusted for injury severity. The odds ratio (OR) of mortality was significantly lower in the EMS physician-treated group of patients: 0.81; 95% confidence interval (CI): 0.71-0.92. When analysis was limited to the studies that were adjusted or matched for injury severity, the OR was 0.86 (95% CI, 0.73-1.01). Analyzing only studies published after 2005 yielded an OR for mortality of 0.75 (95% CI, 0.64-0.88) in the overall analysis and 0.81 (95% CI, 0.67-0.97) in the analysis of adjusted or matched studies. The OR was 0.80 (95% CI, 0.65-1.00) in the subgroup of studies with comparable modes of transport and 0.74 (95% CI, 0.53-1.03) in the more recent studies. CONCLUSION Prehospital management of severely injured patients by EMS teams including a physician seems to be associated with lower mortality. After excluding the confounder of helicopter transport we have shown a nonsignificant trend toward lower mortality. LEVEL OF EVIDENCE Systematic review and meta-analysis, level III.
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Risgaard B, Draegert C, Baekgaard JS, Steinmetz J, Rasmussen LS. Impact of Physician-staffed Helicopters on Pre-hospital Patient Outcomes: A systematic review. Acta Anaesthesiol Scand 2020; 64:691-704. [PMID: 31950487 DOI: 10.1111/aas.13547] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 12/28/2019] [Accepted: 01/03/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Management of pre-hospital patients remains a challenge. In developed countries a physician-staffed helicopter emergency medical service (PS-HEMS) is used in addition to ground emergency medical service (GEMS), but the effect is debated. This systematic review aimed to evaluate the effect of PS-HEMS compared with GEMS on patient outcomes based on the published scientific literature. METHODS Medline, EMBASE and the Cochrane Library were systematically searched on November 15, 2019 for prospective, interventional studies comparing outcomes of patients transported by either PS-HEMS or GEMS. Outcomes of interest were mortality, time to hospital and quality of life. RESULTS The majority of 18 studies included were observational and difficult to summarize because of heterogeneity. Meta-analysis could not be carried out. Three studies found reduced mortality in patients transported by PS-HEMS compared with GEMS with Odds ratios (OR) of 0.68 (0.47-0.98); 0.29 (0.10-0.82) and 0.21 (0.06-0.73) respectively. Another two studies found improved survival with OR 1.2 (1.0-1.5) and 6.9 (1.48-32.5) in patients transported by PS-HEMS compared with GEMS. In three studies, PS-HEMS was associated with shorter time to hospital. Three studies reported quality of life and found no benefit of PS-HEMS. CONCLUSION In this systematic review the studies comparing PS-HEMS with GEMS were difficult to summarize because of heterogeneity. We found a possible survival benefit of PS-HEMS but were unable to conduct a meta-analysis. The overall quality of evidence was low.
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Affiliation(s)
- Bjarke Risgaard
- Department of Anaesthesia Section 4231 Centre of Head and Orthopaedics, Rigshospitalet University of Copenhagen Copenhagen Denmark
| | - Christina Draegert
- Department of Anaesthesia Section 4231 Centre of Head and Orthopaedics, Rigshospitalet University of Copenhagen Copenhagen Denmark
| | - Josefine S. Baekgaard
- Department of Anaesthesia Section 4231 Centre of Head and Orthopaedics, Rigshospitalet University of Copenhagen Copenhagen Denmark
| | - Jacob Steinmetz
- Department of Anaesthesia Section 4231 Centre of Head and Orthopaedics, Rigshospitalet University of Copenhagen Copenhagen Denmark
| | - Lars S. Rasmussen
- Department of Anaesthesia Section 4231 Centre of Head and Orthopaedics, Rigshospitalet University of Copenhagen Copenhagen Denmark
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Masterson S, Deasy C, Doyle M, Hennelly D, Knox S, Sorensen J. What clinical crew competencies and qualifications are required for helicopter emergency medical services? A review of the literature. Scand J Trauma Resusc Emerg Med 2020; 28:28. [PMID: 32299448 PMCID: PMC7164232 DOI: 10.1186/s13049-020-00722-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 04/06/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients served by Helicopter Emergency Medical Services (HEMS) tend to be acutely injured or unwell and in need of stabilisation followed by rapid and safe transport. It is therefore hypothesised that a particular clinical crew composition is required to provide appropriate HEMS patient care. A literature review was performed to test this hypothesis. METHODS MEDLINE, EMBASE, Web of Science and the Cochrane Database of Systematic Reviews were systematically searched from 1 January 2009 to 30 August 2019 to identify peer-reviewed articles of relevance. All HEMS studies that mentioned 'staffing', 'configuration', 'competencies' or 'qualifications' in the title or abstract were selected for full-text review. RESULTS Four hundred one studies were identified. Thirty-eight studies, including one systematic review and one randomised controlled trial, were included. All remaining studies were of an observational design. The vast majority of studies described clinical crews that were primarily doctor-staffed. Descriptions of non-doctor staff competencies were limited, with the exception of one paramedic-staffed model. CONCLUSIONS HEMS clinical crews tended to have a wider range of competencies and experience than ground-based crews, and most studies suggested a patient outcome benefit to HEMS provision. The conclusions that can be drawn are limited due to study quality and the possibility that the literature reviewed was weighted towards particular crewing models (i.e. primarily doctor-staffed) and countries. There is a need for trial-based studies that directly compare patient outcomes between different HEMS crews with different competencies and qualifications.
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Affiliation(s)
- Siobhán Masterson
- Medical Directorate, National Ambulance Service, Dooradoyle House, Dooradoyle Road, Limerick, V94 HW6E, Ireland.
| | - Conor Deasy
- Medical Directorate, National Ambulance Service, Dooradoyle House, Dooradoyle Road, Limerick, V94 HW6E, Ireland.,Emergency Department, Cork University Hospital, Cork, Ireland
| | - Mark Doyle
- Retired Emergency Medicine Consultant, Waterford, Ireland
| | - David Hennelly
- Medical Directorate, National Ambulance Service, Dooradoyle House, Dooradoyle Road, Limerick, V94 HW6E, Ireland
| | - Shane Knox
- National Ambulance Service College, Dublin, Ireland
| | - Jan Sorensen
- Healthcare Outcomes Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
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Aoki M, Abe T, Saitoh D, Hagiwara S, Oshima K. Severe trauma patient volume was associated with decreased mortality. Eur J Trauma Emerg Surg 2020; 47:1957-1964. [PMID: 32222789 DOI: 10.1007/s00068-020-01352-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 03/16/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND The relationship between the severe trauma patient volume and outcomes is still being debated. The aim of this study was to evaluate the relationship between severe trauma patient volume, hospital mortality, and door-to-definitive treatment time. METHODS This was a retrospective cohort study that used recorded data from the Japan Trauma Data Bank. We included severe trauma patients who had an Injury Severity Score greater than 16. Hospitals were categorized according to their annual severe trauma patient volume: low volume, 1-49 (reference), medium volume, 50-99, and high volume, ≥ 100]. The association of volume categories with in-hospital mortality was evaluated by use of a mixed-effects model adjusted for patient demographics and trauma severity. Additionally, the association of volume categories with in-hospital mortality among subgroups and with door-to-definitive treatment time were also evaluated. RESULTS A total of 74,957 severe trauma patients from 213 hospitals were analyzed. In-hospital mortality was 15.7%, 15.2%, and 12.8% in the low volume, medium volume, and high volume groups, respectively. High volume was associated with reduced in-hospital mortality compared to low volume (odds ratio = 0.757, 95% confidence interval = 0.626-0.916). However, medium volume was not associated with reduced in-hospital mortality. Among subgroups, high volume was associated with reduced in-hospital mortality only in the probability of survival ≥ 0.5. Door-to-definitive treatment time was decreased in high volume, however, high volume was not associated with reduced in-hospital mortality among the patients who underwent definitive treatment and the patients whose ps < 0.5. CONCLUSIONS Severe trauma patient volume was associated with decreased mortality by decreasing preventable trauma death.
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Affiliation(s)
- Makoto Aoki
- Department of Emergency Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan.
| | - Toshikazu Abe
- Department of General Medicine, Juntendo University, Tokyo, Japan
- Health Services Research and Development Center, University of Tsukuba, Tsukuba, Japan
| | - Daizoh Saitoh
- Department of Traumatology and Emergency Medicine, National Defense Medical College, Tokorozawa, Japan
| | - Shuichi Hagiwara
- Department of Emergency Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Kiyohiro Oshima
- Department of Emergency Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
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Wu MY, Li CJ, Hou YT, Chen YL, Chang FW, Yiang GT. Analysis of emergency air medical services over 9 years in the Penghu archipelago of Taiwan. Tzu Chi Med J 2020; 32:82-87. [PMID: 32110526 PMCID: PMC7015014 DOI: 10.4103/tcmj.tcmj_216_18] [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: 10/23/2018] [Revised: 11/16/2018] [Accepted: 11/21/2018] [Indexed: 11/16/2022] Open
Abstract
Objective: Emergency air medical services (EAMS) share a common helicopter system for prehospital care and transfer in several countries. In Penghu, two systems are involved in EAMS: the helicopter and C130 systems. Given their features and limitations, patients using the two systems have significantly different characteristics. Materials and Methods: To clearly understand the disease patterns and dynamic changes in transferred patients, we studied 1228 patients transported from Penghu to Taiwan between January 2009 and December 2017. Results: Our findings show that the helicopter group had more acute diseases, while the C130 system group had more chronic diseases. Cardiovascular disease was the most common diagnosis (328 patients, 26.71%), followed by cerebrovascular disease (263 patients, 21.41%) and gastrointestinal disease (221 patients, 17.99%). Following interventions to support local medicine by Tri-Service General Hospital and the establishment of a cardiac catheterization laboratory, the annual number of transported patients decreased, especially those with cardiovascular diseases. The disease pattern also shifted from acute to chronic disease. Conclusion: Current data indicate that the local medical system is developing the ability to manage chronic diseases and care problems. This article analyzes dynamic changes in the disease patterns of transferred patients in both EAMS groups, providing a strong foundation for developing local medical systems.
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Affiliation(s)
- Meng-Yu Wu
- Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan.,Department of Emergency Medicine, School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Chia-Jung Li
- Research Assistant Center, Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Yueh-Tseng Hou
- Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan.,Department of Emergency Medicine, School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Yu-Long Chen
- Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan.,Department of Emergency Medicine, School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Fung-Wei Chang
- Department of Obstetrics and Gynecology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.,Office of Superintendent, Tri-Service General Hospital Penghu Branch, National Defence Medical Center, Peghu, Taiwan
| | - Giou-Teng Yiang
- Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan.,Department of Emergency Medicine, School of Medicine, Tzu Chi University, Hualien, Taiwan
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Factors influencing vehicle passenger fatality have changed over 10 years: a nationwide hospital-based study. Sci Rep 2020; 10:3316. [PMID: 32094429 PMCID: PMC7040014 DOI: 10.1038/s41598-020-60222-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 02/10/2020] [Indexed: 11/22/2022] Open
Abstract
Traffic injury trends have changed with safety developments. To establish effective preventive measures against traffic fatalities, the factors influencing fatalities must be understood. The present study evaluated data from a national medical database to determine the changes in these factors over time, as this has not been previously investigated. This observational study retrospectively analysed data from the Japanese Trauma Data Bank. Vehicle passengers involved in collisions from 2004–2008 and 2016–2017 were included. Data were compared between the two study periods, and between fatal and non-fatal patients within each period. Multivariate logistic regression analyses were performed to determine the factors influencing fatalities. In 2016–2017, patients were older and had lower fatality rates. In 2004–2008, fatalities were more likely to involve older male front-seat passengers with low d-BP, BT, and GCS values, and high AIS of the neck and abdomen. However, in 2016–2017, fatalities were more likely to involve older males with low GCS, high AIS of the abdomen, and positive focused assessment with sonography for trauma results. Our study identified independent factors influencing vehicle passenger fatalities, which will likely continue to evolve with the aging of the population and changing manners of injury.
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Reimer AP. Prehospital and Transport Nursing: The Next 50 Years. J Emerg Nurs 2020; 46:8-11. [DOI: 10.1016/j.jen.2019.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 11/23/2019] [Accepted: 11/23/2019] [Indexed: 10/25/2022]
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Ueno T, Nishijima H, Hikichi H, Haga R, Arai A, Suzuki C, Nunomura JI, Saito K, Tomiyama M. Helicopter Transport for Patients with Cerebral Infarction in Rural Japan. J Stroke Cerebrovasc Dis 2019; 28:2525-2529. [DOI: 10.1016/j.jstrokecerebrovasdis.2019.06.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 05/28/2019] [Accepted: 06/09/2019] [Indexed: 11/28/2022] Open
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Leveraging Data Quality to Better Prepare for Process Mining: An Approach Illustrated Through Analysing Road Trauma Pre-Hospital Retrieval and Transport Processes in Queensland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16071138. [PMID: 30934913 PMCID: PMC6479847 DOI: 10.3390/ijerph16071138] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 03/22/2019] [Accepted: 03/23/2019] [Indexed: 11/17/2022]
Abstract
While noting the importance of data quality, existing process mining methodologies (i) do not provide details on how to assess the quality of event data (ii) do not consider how the identification of data quality issues can be exploited in the planning, data extraction and log building phases of any process mining analysis, (iii) do not highlight potential impacts of poor quality data on different types of process analyses. As our key contribution, we develop a process-centric, data quality-driven approach to preparing for a process mining analysis which can be applied to any existing process mining methodology. Our approach, adapted from elements of the well known CRISP-DM data mining methodology, includes conceptual data modeling, quality assessment at both attribute and event level, and trial discovery and conformance to develop understanding of system processes and data properties to inform data extraction. We illustrate our approach in a case study involving the Queensland Ambulance Service (QAS) and Retrieval Services Queensland (RSQ). We describe the detailed preparation for a process mining analysis of retrieval and transport processes (ground and aero-medical) for road-trauma patients in Queensland. Sample datasets obtained from QAS and RSQ are utilised to show how quality metrics, data models and exploratory process mining analyses can be used to (i) identify data quality issues, (ii) anticipate and explain certain observable features in process mining analyses, (iii) distinguish between systemic and occasional quality issues, and (iv) reason about the mechanisms by which identified quality issues may have arisen in the event log. We contend that this knowledge can be used to guide the data extraction and pre-processing stages of a process mining case study to properly align the data with the case study research questions.
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Reimer AP, Schiltz NK, Ho VP, Madigan EA, Koroukian SM. Applying Supervised Machine Learning to Identify Which Patient Characteristics Identify the Highest Rates of Mortality Post-Interhospital Transfer. BIOMEDICAL INFORMATICS INSIGHTS 2019; 11:1178222619835548. [PMID: 30911219 PMCID: PMC6425528 DOI: 10.1177/1178222619835548] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 02/04/2019] [Indexed: 01/15/2023]
Abstract
Objective: To demonstrate the usefulness of applying supervised machine-learning analyses to identify specific groups of patients that experience high levels of mortality post-interhospital transfer. Methods: This was a cross-sectional analysis of data from the Health Care Utilization Project 2013 National Inpatient Sample, that applied supervised machine-learning approaches that included (1) classification and regression tree to identify mutually exclusive groups of patients and their associated characteristics of those experiencing the highest levels of mortality and (2) random forest to identify the relative importance of each characteristic’s contribution to post-transfer mortality. Results: A total of 21 independent groups of patients were identified, with 13 of those groups exhibiting at least double the national average rate of mortality post-transfer. Patient characteristics identified as influencing post-transfer mortality the most included: diagnosis of a circulatory disorder, comorbidity of coagulopathy, diagnosis of cancer, and age. Conclusions: Employing supervised machine-learning analyses enabled the computational feasibility to assess all potential combinations of available patient characteristics to identify groups of patients experiencing the highest rates of mortality post-interhospital transfer, providing potentially useful data to support developing clinical decision support systems in future work.
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Affiliation(s)
- Andrew P Reimer
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA.,Critical Care Transport, Cleveland Clinic, Cleveland, OH, USA
| | - Nicholas K Schiltz
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Vanessa P Ho
- Division of Trauma/Burn Care, MetroHealth Medical Center, Cleveland, OH, USA
| | | | - Siran M Koroukian
- Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
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Prehospital quick sequential organ failure assessment score to predict in-hospital mortality among patients with trauma. Am J Emerg Med 2019; 37:2165-2170. [PMID: 30878407 DOI: 10.1016/j.ajem.2019.03.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 03/04/2019] [Accepted: 03/07/2019] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE The quick sequential organ failure assessment (qSOFA) score is calculated from three variables measured at the scene of trauma-systolic blood pressure, respiratory rate and consciousness. This study aimed to evaluate the discriminative ability of the prehospital qSOFA score for in-hospital mortality in patients with trauma. METHODS This retrospective multicenter study used data from 42,722 patients with trauma included in a Japanese nationwide trauma registry. All included patients were aged ≥18 years old and transferred to hospitals from the scenes of injury. The primary outcome was in-hospital mortality. RESULTS The included patients had a mean age of 59.4 ± 21.5 years and a male predominance (63%). In-hospital mortality occurred in 2612 patients (6%), while 2-day mortality occurred in 1189 of 42,339 patients (3%). When patients were stratified by qSOFA scores, in-hospital mortality rates of 0.9% (105/11783), 5% (941/17839), 12% (1280/11132) and 15% (286/1968) were associated with qSOFA scores of 0, 1, 2 and 3, respectively (P < 0.0001 for trend). The area under the receiver operating characteristics curve of the qSOFA score for in-hospital mortality was 0.70 (95% confidence interval: 0.69-0.71). A qSOFA score cutoff value ≥1 yielded a sensitivity and specificity of 0.96 and 0.29, respectively, overall, and a sensitivity of 0.99 in patients younger than 65 years. CONCLUSIONS The prehospital qSOFA score was strongly associated with in-hospital mortality in patients with trauma. A prehospital qSOFA score cutoff of ≥1 can be used to identify patients at a very low risk of death, especially in younger age groups.
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Andicochea CT, Wilson J, Raetz E, Walrath B. An Assessment of Flight Surgeon Confidence to Perform En Route Care. Mil Med 2019; 184:306-309. [DOI: 10.1093/milmed/usy281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 09/28/2018] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
En Route Care (ERC) is often an ad hoc mission for the USN. In a review of 428 Navy patient transports, a Flight Surgeon (FS) was the sole provider or a member of crew in 118 of the transports. Naval FSs receive approximately 4 hours of didactic ERC training during their 24-week Naval FS course. Regardless, an FS may be caring for a critically ill patient in a helicopter. We conducted a survey to evaluate FS confidence in their ability to perform ERC and to establish their understanding of the training of Search and Rescue Medical Technicians (SMT).
Materials and Methods
A convenience sample of FSs completed a needs analysis survey as part of a process improvement project. Flight Surgeons surveyed were actively assigned or had been assigned within the past year to a squadron with Search and Rescue/MEDEVAC capabilities.
Results
A total of 25 surveys were completed. An average of 13 (range 0–100) patient transport missions were performed by the respondents. Twenty-five percent reported feeling confident in their ability to provide ERC without senior level direction, while 41% stated they would require direction. Nearly 70% of the FSs surveyed expressed “minimal” or less understanding of the training of the SMT.
Conclusions
Our survey results reveal most FSs are confident in neither their ability to perform ERC nor the ability of their hospital corpsman to provide care during patient movement.
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Affiliation(s)
- Chad T Andicochea
- Naval Medical Center San Diego, Department of Emergency Medicine, 34800 Bob Wilson Dr, San Diego, CA
| | - James Wilson
- Naval Medical Center San Diego, Department of Internal Medicine, 34800 Bob Wilson Dr, San Diego, CA
| | - Emily Raetz
- Naval Medical Center San Diego, Department of Emergency Medicine, 34800 Bob Wilson Dr, San Diego, CA
| | - Benjamin Walrath
- Naval Medical Center San Diego, Department of Emergency Medicine, 34800 Bob Wilson Dr, San Diego, CA
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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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Matsumoto S, Jung K, Smith A, Yamazaki M, Kitano M, Coimbra R. Comparison of trauma outcomes between Japan and the USA using national trauma registries. Trauma Surg Acute Care Open 2018; 3:e000247. [PMID: 30539156 PMCID: PMC6241981 DOI: 10.1136/tsaco-2018-000247] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background The National Trauma Data Bank (NTDB) has served as a global benchmark for trauma care quality and outcomes. Herein, we compared patient characteristics, trauma management, and outcomes between Japanese emergency and critical care centers and US level 1 trauma centers using the Japanese Trauma Data Bank (JTDB) and NTDB. Methods A retrospective cohort matching (1:1) study was performed. Patients treated in 2013 with an Injury Severity Score ≥9 were included. The primary outcome measure was in-hospital mortality. The secondary outcome measures included the hospital length of stay and the rate of use of radiological diagnostic modalities. Results A total of 14 960 pairs with well-balanced characteristics were generated from 22 535 and 112 060 eligible patients in the JTDB and NTDB, respectively. Before matching, the in-hospital mortality was higher in the JTDB than in the NTDB (7.6% vs. 6.1%; OR, 1.28; 95% CI 1.21 to 1.35). However, after matching, the in-hospital mortality was lower in the JTDB cohort (4.2% vs. 5.8%; OR, 0.72; 95% CI 0.65 to 0.80). CT scans were used in >80% of JTDB patients, which was more than 1.5 times as often as the use in the NTDB cohort. In subgroup analyses, only patients who received a blood transfusion had a poorer survival outcome in the JTDB compared with the NTDB (OR, 1.32; 95% CI 1.07 to 1.64). Discussion We observed marked differences in trauma care between Japan and the USA. Although the quality of the recent Japanese trauma care appears to be approaching that of the USA, it may be further improved, such as by the establishment of transfusion protocols. Level of evidence Level IV.
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Affiliation(s)
- Shokei Matsumoto
- Division of Trauma, Surgical Critical Care, Burns, and Acute Care Surgery, University of California San Diego, San Diego, California, USA.,Department of Trauma and Emergency Surgery, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan
| | - Kyoungwon Jung
- Division of Trauma, Surgical Critical Care, Burns, and Acute Care Surgery, University of California San Diego, San Diego, California, USA.,Division of Trauma Surgery, Department of Surgery, Ajou University School of Medicine, Suwon, South Korea
| | - Alan Smith
- Division of Trauma, Surgical Critical Care, Burns, and Acute Care Surgery, University of California San Diego, San Diego, California, USA
| | - Motoyasu Yamazaki
- Department of Trauma and Emergency Surgery, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan
| | - Mitsuhide Kitano
- Department of Trauma and Emergency Surgery, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan
| | - Raul Coimbra
- Riverside University Health System Medical Center and Loma Linda University School of Medicine, Riverside, California, USA
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Landreau F, Valcarcel O, Noir J, Pernía G, Orzábal ML, Martínez S, Tobar A, Isola M, Núñez M, Martínez P, Cuellar C, Villagrán F, Crescenti A. Helicopter Emergency Medical Services in Buenos Aires: An Operational Overview. Air Med J 2018; 37:367-370. [PMID: 30424854 DOI: 10.1016/j.amj.2018.07.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 06/12/2018] [Accepted: 07/22/2018] [Indexed: 06/09/2023]
Abstract
As part of the emergency medical care system, helicopter emergency medical services (HEMS) have a different crew composition from the traditional team. HEMS consist of a pilot, doctor, and firefighter with rescue skills and training in basic life support on board an air ambulance. This allows the adaptation to different environments and increases the varieties of air procedures normally performed. HEMS began operating relatively recently in Buenos Aires. Yet, in 3 years, its use grew to such an extent that in 2015 it tripled, and by 2016 the number of medical assists was 4 times greater than in 2014. Furthermore, over the 3-year study period, 92% to 95% of assisted victims were traffic accident casualties requiring primary care. The HEMS crew is informed about the availability of resources in the acute care general hospitals and can therefore transfer patients to the most appropriate trauma center in the shortest time. However, 75% to 85% of the time, the choice of destination is strongly influenced by the availability of a helipad and the operational safety that it provides.
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Affiliation(s)
- Fernando Landreau
- Escuadrón Aéreo del Emergency Medical Care System, Buenos Aires; HGA (Hospital General de Agudos) Dalmacio Velez Sarsfield, Buenos Aires.
| | - Oscar Valcarcel
- Dirección General Emergency Medical Care System, Buenos Aires
| | - Juan Noir
- Escuadrón Aéreo del Emergency Medical Care System, Buenos Aires; HGA (Hospital General de Agudos) Dr. Cosme Argerich, Buenos Aires
| | - Guadalupe Pernía
- Escuadrón Aéreo del Emergency Medical Care System, Buenos Aires; HGA (Hospital General de Agudos) Dr. Ramos Mejía, Buenos Aires
| | - María L Orzábal
- Escuadrón Aéreo del Emergency Medical Care System, Buenos Aires; HGA (Hospital General de Agudos) Dalmacio Velez Sarsfield, Buenos Aires
| | - Sergio Martínez
- Escuadrón Aéreo del Emergency Medical Care System, Buenos Aires; HGA (Hospital General de Agudos) Dr. Juan A. Fernandez, Buenos Aires
| | - Alejandro Tobar
- Escuadrón Aéreo del Emergency Medical Care System, Buenos Aires; HGA (Hospital General de Agudos) Dalmacio Velez Sarsfield, Buenos Aires
| | - Mariana Isola
- Escuadrón Aéreo del Emergency Medical Care System, Buenos Aires; HGA (Hospital General de Agudos) Dr. Ramos Mejía, Buenos Aires
| | - Mariano Núñez
- Escuadrón Aéreo del Emergency Medical Care System, Buenos Aires; HGA (Hospital General de Agudos) Dr. Juan A. Fernandez, Buenos Aires
| | - Pablo Martínez
- Escuadrón Aéreo del Emergency Medical Care System, Buenos Aires; HGA (Hospital General de Agudos) Donación Francisco Santojanni, Buenos Aires
| | - Cristian Cuellar
- Escuadrón Aéreo del Emergency Medical Care System, Buenos Aires; HGA (Hospital General de Agudos) Dr. Cosme Argerich, Buenos Aires
| | - Federico Villagrán
- Escuadrón Aéreo del Emergency Medical Care System, Buenos Aires; HGA (Hospital General de Agudos) Donación Francisco Santojanni, Buenos Aires
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Knapp J, Pietsch U, Kreuzer O, Hossfeld B, Bernhard M, Lier H. Prehospital Blood Product Transfusion in Mountain Rescue Operations. Air Med J 2018; 37:392-399. [PMID: 30424860 DOI: 10.1016/j.amj.2018.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 07/08/2018] [Accepted: 08/24/2018] [Indexed: 12/13/2022]
Abstract
Severely injured patients with hemorrhage present major challenges for emergency medical services, especially during mountain rescue missions in which harsh environmental conditions and long out-of-hospital times are frequent. Because uncontrolled hemorrhage is the leading cause of death within the first 48 hours after severe trauma, initiating damage control resuscitation (DCR) as early as possible after severe trauma and exporting the concept of DCR to the out-of-hospital arena is pivotal for patient survival. Appropriate bleeding control, management of coagulopathy, and transfusion of blood products are core aspects of DCR. This review summarizes the available evidence on out-of-hospital blood product transfusion and the management of coagulopathy with a special focus on mountain rescue missions. An overview of upcoming trials and possible future trends in the management of coagulopathy during rescue operations is provided.
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Affiliation(s)
- Jürgen Knapp
- Department of Anaesthesiology and Pain Therapy, University Hospital of Bern, Bern, Switzerland; Air Zermatt, Emergency Medical Service, Zermatt, Switzerland.
| | - Urs Pietsch
- Air Zermatt, Emergency Medical Service, Zermatt, Switzerland; Department of Anaesthesiology and Intensive Care Medicine, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - Oliver Kreuzer
- Air Zermatt, Emergency Medical Service, Zermatt, Switzerland
| | - Björn Hossfeld
- Department of Anaesthesiology and Intensive Care Medicine, Armed Forces Hospital Ulm, Ulm, Germany; Task Force "Tactical Medicine" of the Scientific Working Group Emergency Medicine of the German Society of Anaesthesiology and Intensive Care Medicine, Nürnberg, Germany
| | - Michael Bernhard
- Emergency Department, University Hospital of Düsseldorf, Düsseldorf, Germany; Task Force "Trauma and Resuscitation Room Management" of the Scientific Working Group Emergency Medicine of the German Society of Anaesthesiology and Intensive Care Medicine, Nürnberg, Germany
| | - Heiko Lier
- Task Force "Tactical Medicine" of the Scientific Working Group Emergency Medicine of the German Society of Anaesthesiology and Intensive Care Medicine, Nürnberg, Germany; Department of Anaesthesiology and Postoperative Intensive Care Medicine, University of Cologne, Köln, Germany
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Duke M, Tatum D, Sexton K, Stuke L, Robertson R, Sutherland M, Tyroch A, Agrawal V, Duchesne J. When Minutes Fly by: What is the True “Golden Hour” for Air Care? Am Surg 2018. [DOI: 10.1177/000313481808400633] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Air transport was developed to hasten patient transport based on the “golden hour” belief that delayed care leads to poorer outcome. The primary aim of our study was to identify the critical inflection point of increased nonsurvivors on total prehospital time. This was a multicenter review of adult trauma patients transported by air between November 2014 and August 2015. Primary outcome of interest was all-cause inhospital mortality. Total helicopter emergency medical services times of nonsurvivors were plotted to visualize the distribution of prehospital time. Of 636 patients included, 71 per cent were male and 86 per cent suffered blunt trauma. Among non-survivors, mortality doubled once total helicopter emergency medical services time exceeded 30 minutes (P < 0.001). Nonsurvivors presented with significantly lower median [interquartile range (IQR)] Glasgow Coma Score compared with survivors [3 (3–13) vs 15 (12–15), respectively; P < 0.001] as well as a significantly higher median (IQR) Injury Severity Score [26 (19–41) vs 12 (5–22); P < 0.001], increased incidence of penetrating mechanism of injury [21 vs 8%; P = 0.002], and higher median (IQR) shock index [0.84 (0.63–1.06) vs 0.71 (0.6–0.87); P = 0.023]. We identified an inflection point of doubling in mortality after 30 minutes. This suggests a possible threshold effect between time and mortality in severely injured patients. Revised field criteria for determining which injured patients would most benefit from helicopter transport are needed.
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Affiliation(s)
| | - Danielle Tatum
- Our Lady of the Lake Regional Medical Center, Baton Rouge, Louisiana
| | - Kevin Sexton
- University of Arkansas Medical Center, Little Rock, Arkansas
| | - Lance Stuke
- Louisiana State University Medical Center, New Orleans, Louisiana
| | | | | | - Alan Tyroch
- Texas Tech University Health Science Center, Lubbock, Texas
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