Cancellations of (helicopter-transported) mobile medical team dispatches in the Netherlands

Abstract

BackgroundThe trauma centre of the Trauma Center Region North-West Netherlands (TRNWN) has consensus criteria for Mobile Medical Team (MMT) scene dispatch. The MMT can be dispatched by the EMS-dispatch centre or by the on-scene ambulance crew and is transported by helicopter or ground transport. Although much attention has been paid to improve the dispatch criteria, the MMT is often cancelled after being dispatched. The aim of this study was to assess the cancellation rate and the noncompliant dispatches of our MMT and to identify factors associated with this form of primary overtriage.MethodsBy retrospective analysis of all MMT dispatches in the period from 1 July 2006 till 31 December 2006 using chart review, we conducted a consecutive case review of 605 dispatches. Four hundred and sixty seven of these were included for our study, collecting data related to prehospital triage, patient’s condition on-scene and hospital course.ResultsAverage age was 35.9 years; the majority of the patients were male (65.3%). Four hundred and thirty patients were victims of trauma, sustaining injuries in most cases from blunt trauma (89.3%). After being dispatched, the MMT was cancelled 203 times (43.5%). Statistically significant differences between assists and cancellations were found for overall mortality, mean RTS, GCS and ISS, mean hospitalization, length and amount of ICU admissions (p < 0.001). All dispatches were evaluated by using the MMT-dispatch criteria and mission appropriateness criteria. Almost 26% of all dispatches were neither appropriate, nor met the dispatch criteria. Fourteen missions were appropriate, but did not meet the dispatch criteria. The remaining 318 dispatches had met the dispatch criteria, of which 135 (30.3%) were also appropriate. The calculated additional costs of the cancelled dispatches summed up to a total of € 34,448, amounting to 2.2% of the total MMT costs during the study period.ConclusionIn our trauma system, the MMT dispatches are involved with high rates of overtriage. After being dispatched, the MMT is cancelled in almost 50% of all cases. We found an undertriage rate of 4%, which we think is acceptable. All cancellations were justified. The additional costs of the cancelled missions were within an acceptable range. According to this study, it seems to be possible to reduce the overtriage rate of the MMT dispatches, without increasing the undertriage rate to non-acceptable levels.

Helicopter‐based emergency medical services for a sparsely populated region: A study of 42,500 dispatches

“…Our proportion of cancelations compares well with similar services 10, 11. Among several reasons for cancelations, the most common was “no indication,” especially at night.…”

Activation Intervals for a Helicopter Emergency Medical Service in Japan

“…Although it is recognized that this triage method will result in over-triage and over-cancellation of HEMS, a certain amount of over-triage is deemed necessary. Giannakopoulos and colleagues 16 have reported that a low HEMS activation threshold prior to evaluating patients at the scene (Primary Launch Criteria) resulted in a 43.5% flight cancellation rate and 4.0% under-triage. They concluded that this combination of over-triage (cancellation) and under-triage were acceptable and that the additional costs of cancelled missions were within an acceptable range.…”

Criteria for cancelling helicopter emergency medical Services (HEMS) dispatches

“…A previous study showed that Dutch HEMS are associated with high levels of primary overtriage, resulting in cancellation of the missions by the already on-scene ground ambulance, before HEMS even arrives on the scene of the accident 9. In our trauma system there is no consensus about standardised criteria for cancelling deployed HEMS.…”