Effects of physician-based emergency medical service dispatch in severe traumatic brain injury on prehospital run time

Franschman, Gaby; Verburg, Niels; Brens-Heldens, V.; Andriessen, Teuntje M. J. C.; Naalt, Joukje van der; Peerdeman, Saskia M.; Valk, Jens P; Hoogerwerf, Nico; Greuters, Sjoerd; Schober, Patrick; Vos, Pieter E.; Christiaans, H.M.T.; Boer, Christa

doi:10.1016/j.injury.2012.05.020

Cited by 39 publications

(43 citation statements)

References 19 publications

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“…This can be explained by the increased number of complex interventions performed in these cases (including RSI and thoracostomy) and is consistent with findings from other HEMS 13 14. The increase in on-scene time was not, however, associated with a significant increase in overall mission or case timings, a finding consistent with studies in other HEMS systems 15. These findings indicate that patients are receiving a greater number of enhanced-care interventions at the scene since the introduction of the MTN without the time taken to reach hospital being adversely affected.…”

Section: Discussionsupporting

confidence: 87%

Impact of introducing a major trauma network on a regional helicopter emergency medicine service in the UK

et al. 2013

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Section: Discussionsupporting

confidence: 87%

Impact of introducing a major trauma network on a regional helicopter emergency medicine service in the UK

et al. 2013

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“…[910] In some systems, air medical crews may provide a higher level of care but may require longer transport times. Based on the analysis of data (2049 patients) from two randomized trials of pre-hospital hypertonic resuscitation, patients transported by air (in comparison with ground transport) had higher rates of pre-hospital intubation (81% vs. 36%), received more intravenous fluids (mean 1.3 L vs. 0.8 L) and had longer pre-hospital times (mean 76.1 min vs. 43.5 min).…”

Section: Methodsmentioning

confidence: 99%

“…[11] In addition, a retrospective study of 497 patients with severe TBI showed that in comparison with paramedics, physician-lead helicopter emergency services were found to have a more favorable outcome and mortality scores and there were also similar pre-hospital run times between the two groups. [10] Therefore, there is a need to integrate the most effective transport system through which patients of TBI can be shifted to a specialized trauma center within the minimum possible time. The time is a crucial factor for the occurrence as well as the prevention of secondary brain injury; therefore, the transport vehicle should have all possible drugs/equipment and monitoring devices.…”

Section: Methodsmentioning

confidence: 99%

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Pre-hospital and initial management of head injury patients: An update

et al. 2014

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Background:Most of the bad outcomes in patients with severe traumatic brain injury (TBI) are related to the presence of a high incidence of pre-hospital secondary brain insults. Therefore, knowledge of these variables and timely management of the disease at the pre-hospital period can significantly improve the outcome and decrease the mortality. The Brain Trauma Foundation guideline on “Prehospital Management” published in 2008 could provide the standardized protocols for the management of patients with TBI; however, this guideline has included the relevant papers up to 2006.Methods:A PubMed search for relevant clinical trials and reviews (from 1 January 2007 to 31 March 2013), which specifically discussed about the topic, was conducted.Results:Based on the evidence, majority of the management strategies comprise of rapid correction of hypoxemia and hypotension, the two most important predictors for mortality. However, there is still a need to define the goals for the management of hypotension and inclusion of newer difficult airway carts as well as proper monitoring devices for ensuring better intubation and ventilatory management. Isotonic saline should be used as the first choice for fluid resuscitation. The pre-hospital hypothermia has more adverse effects; therefore, this should be avoided.Conclusion:Most of the management trials published after 2007 have focused mainly on the treatment as well as the prevention strategies for secondary brain injury. The results of these trials would be certainly adopted by new standardized guidelines and therefore may have a substantial impact on the pre-hospital management in patients with TBI.

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“…HEMS operations are utterly time-critical [13], for example, concept of the Golden Hour , and prolonged or repeated on-scene measurements should be avoided. Moreover, the head of trauma patients is routinely immobilized during transport, for example, with head blocks and head straps, limiting access to the head measurement points.…”

Section: Introductionmentioning

confidence: 99%

Intracranial Hematoma Detection by Near Infrared Spectroscopy in a Helicopter Emergency Medical Service: Practical Experience

Schober

Bossers

Schwarte

2017

BioMed Research International

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In (helicopter) emergency medical services, (H)EMS, the prehospital detection of intracranial hematomas should improve patient care and the triage to specialized neurosurgical hospitals. Recently, noninvasive detection of intracranial hematomas became possible by applying transcranial near infrared spectroscopy (NIRS). Herein, second-generation devices are currently available, for example, the Infrascanner 2000 (Infrascan), that appear suited also for prehospital (H)EMS applications. Since (H)EMS operations are time-critical, we studied the Infrascanner 2000 as a “first-time-right” monitor in healthy volunteers (n = 17, hospital employees, no neurologic history). Further, we studied the implementation of the Infrascanner 2000 in a European HEMS organization (Lifeliner 1, Amsterdam, The Netherlands). The principal results of our study were as follows: The screening for intracranial hematomas in healthy volunteers with first-time-right intention resulted in a marked rate of virtual hematomas (false positive results, i.e., 12/17), rendering more time consuming repeat measurements advisable. The results of the implementation of the Infrascanner in HEMS suggest that NIRS-based intracranial hematoma detection is feasible in the HEMS setting. However, some drawbacks exist and their possible solutions are discussed. Future studies will have to demonstrate how NIRS-based intracranial hematoma detection will improve prehospital decision making in (H)EMS and ultimately patient outcome.

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Effects of physician-based emergency medical service dispatch in severe traumatic brain injury on prehospital run time

Cited by 39 publications

References 19 publications

Impact of introducing a major trauma network on a regional helicopter emergency medicine service in the UK

Impact of introducing a major trauma network on a regional helicopter emergency medicine service in the UK

Pre-hospital and initial management of head injury patients: An update

Intracranial Hematoma Detection by Near Infrared Spectroscopy in a Helicopter Emergency Medical Service: Practical Experience

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