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Tucker H, Griggs JE, Gavrilovski M, Rahman S, Simpson C, Lyon RM, Hudson A. Prehospital Management of Penetrating Neck Injuries: An Evaluation of Practice. Air Med J 2024; 43:23-27. [PMID: 38154835 DOI: 10.1016/j.amj.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 09/02/2023] [Indexed: 12/30/2023]
Abstract
OBJECTIVE Penetrating neck injuries (PNIs) can occur at multiple anatomic sites and involve airway, nerve, vascular, and gastrointestinal structures. They pose a unique challenge to clinicians, especially in the prehospital setting. Published guidance on the prehospital management of PNIs is limited, and there is no review of the current prehospital practice. METHODS A retrospective electronic case note review of PNIs managed within 1 UK helicopter emergency medical service (HEMS) over a 7-year period was undertaken. Data were collected on the zone of injury, mechanism of injury, prehospital times, patient demographics, prehospital interventions, and on-scene mortality. RESULTS Ninety-eight patients met the study inclusion criteria, 40% of whom had zone 2 neck injuries. Eighty-three percent were male with a mean age of 42 years. The predominant injury mechanism was interpersonal violence (51%) followed by self-harm (47%). Fifteen percent underwent prehospital emergency anesthesia, 17% underwent prehospital blood transfusion, and 30% had a hemostatic dressing applied. No patients underwent cervical spine immobilization. One percent underwent resuscitative thoracotomy. Five percent were pronounced life extinct after HEMS arrival following interventions by the HEMS team. CONCLUSION Time-critical and emergent interventions in this select patient population must be minimal and focus on optimizing care during rapid transfer to the hospital. Airway and hemorrhagic pathologies must be managed, often concomitantly. Targeted injury prevention to reduce interpersonal violence must ensue. The author group intends to devise a national Delphi and derive consensus guidelines for the management of prehospital PNIs.
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Affiliation(s)
- Harriet Tucker
- Air Ambulance Charity Kent Surrey Sussex, Surrey, United Kingdom; St George's Hospital, London, United Kingdom
| | - Joanne E Griggs
- Air Ambulance Charity Kent Surrey Sussex, Surrey, United Kingdom; School of Health Sciences, University of Surrey, Guildford, Surrey, United Kingdom.
| | - Maja Gavrilovski
- Air Ambulance Charity Kent Surrey Sussex, Surrey, United Kingdom; St Thomas' Hospital, London, United Kingdom
| | - Shah Rahman
- Air Ambulance Charity Kent Surrey Sussex, Surrey, United Kingdom
| | | | - Richard M Lyon
- Air Ambulance Charity Kent Surrey Sussex, Surrey, United Kingdom; School of Health Sciences, University of Surrey, Guildford, Surrey, United Kingdom
| | - Anthony Hudson
- Air Ambulance Charity Kent Surrey Sussex, Surrey, United Kingdom; St George's Hospital, London, United Kingdom
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Sunde GA, Bjerkvig C, Bekkevold M, Kristoffersen EK, Strandenes G, Bruserud Ø, Apelseth TO, Heltne JK. Implementation of a low-titre whole blood transfusion program in a civilian helicopter emergency medical service. Scand J Trauma Resusc Emerg Med 2022; 30:65. [PMID: 36494743 PMCID: PMC9733220 DOI: 10.1186/s13049-022-01051-z] [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] [Received: 09/28/2022] [Accepted: 11/22/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Early balanced transfusion is associated with improved outcome in haemorrhagic shock patients. This study describes the implementation and evaluates the safety of a whole blood transfusion program in a civilian helicopter emergency medical service (HEMS). METHODS This prospective observational study was performed over a 5-year period at HEMS-Bergen, Norway. Patients in haemorrhagic shock receiving out of hospital transfusion of low-titre Group O whole blood (LTOWB) or other blood components were included. Two LTOWB units were produced weekly and rotated to the HEMS for forward storage. The primary endpoints were the number of patients transfused, mechanisms of injury/illness, adverse events and survival rates. Informed consent covered patient pathway from time of emergency interventions to last endpoint and subsequent data handling/storage. RESULTS The HEMS responded to 5124 patients. Seventy-two (1.4%) patients received transfusions. Twenty patients (28%) were excluded due to lack of consent (16) or not meeting the inclusion criteria (4). Of the 52 (100%) patients, 48 (92%) received LTOWB, nine (17%) received packed red blood cells (PRBC), and nine (17%) received freeze-dried plasma. Of the forty-six (88%) patients admitted alive to hospital, 35 (76%) received additional blood transfusions during the first 24 h. Categories were blunt trauma 30 (58%), penetrating trauma 7 (13%), and nontrauma 15 (29%). The majority (79%) were male, with a median age of 49 (IQR 27-70) years. No transfusion reactions, serious complications or logistical challenges were reported. Overall, 36 (69%) patients survived 24 h, and 28 (54%) survived 30 days. CONCLUSIONS Implementing a whole blood transfusion program in civilian HEMS is feasible and safe and the logistics around out of hospital whole blood transfusions are manageable. Trial registration The study is registered in the ClinicalTrials.gov registry (NCT02784951).
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Affiliation(s)
- Geir Arne Sunde
- grid.412008.f0000 0000 9753 1393Department of Anesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway ,Helicopter Emergency Medical Services, Bergen, Norway
| | - Christopher Bjerkvig
- grid.412008.f0000 0000 9753 1393Department of Anesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway ,Helicopter Emergency Medical Services, Bergen, Norway ,grid.7914.b0000 0004 1936 7443Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Marit Bekkevold
- grid.420120.50000 0004 0481 3017Department of Research, Norwegian Air Ambulance Foundation, Oslo, Norway ,grid.55325.340000 0004 0389 8485Division of Prehospital Services, Air Ambulance Department, Oslo University Hospital, Oslo, Norway
| | - Einar K. Kristoffersen
- grid.7914.b0000 0004 1936 7443Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway ,grid.412008.f0000 0000 9753 1393Department of Immunology and Transfusion Medicine, Haukeland University Hospital, Bergen, Norway
| | - Geir Strandenes
- grid.412008.f0000 0000 9753 1393Department of Immunology and Transfusion Medicine, Haukeland University Hospital, Bergen, Norway
| | - Øyvind Bruserud
- grid.412008.f0000 0000 9753 1393Department of Anesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
| | - Torunn Oveland Apelseth
- grid.7914.b0000 0004 1936 7443Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway ,grid.412008.f0000 0000 9753 1393Department of Immunology and Transfusion Medicine, Haukeland University Hospital, Bergen, Norway ,grid.457897.00000 0004 0512 8409Norwegian Armed Forces Joint Medical Service, Sessvollmoen, Norway
| | - Jon-Kenneth Heltne
- grid.412008.f0000 0000 9753 1393Department of Anesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway ,Helicopter Emergency Medical Services, Bergen, Norway ,grid.7914.b0000 0004 1936 7443Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway
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