Impact of a physician‐staffed helicopter on a regional trauma system: a prospective, controlled, observational study

Abstract

IntroductionThis study aims to compare the trauma system before and after implementing a physician-staffed helicopter emergency medical service (PS-HEMS). Our hypothesis was that PS-HEMS would reduce time from injury to definitive care for severely injured patients.MethodsThis was a prospective, controlled, observational study, involving seven local hospitals and one level I trauma centre using a before and after design. All patients treated by a trauma team within a 5-month period (1 December 2009–30 April 2010) prior to and a 12-month period (1 May 2010–30 April 2011) after implementing a PS-HEMS were included.We compared time from dispatch of the first ground ambulance to arrival in the trauma centre for patients with Injury Severity Score (ISS) > 15. Secondary end points were the proportion of secondary transfers and 30-day mortality.ResultsWe included 1788 patients, of which 204 had an ISS > 15. The PS-HEMS transported 44 severely injured directly to the trauma centre resulting in a reduction of secondary transfers from 50% before to 34% after implementation (P = 0.04). Median delay for definitive care for severely injured patients was 218 min before and 90 min after implementation (P < 0.01). The 30-day mortality was reduced from 29% (16/56) before to 14% (21/147) after PS-HEMS (P = 0.02). Logistic regression showed PS-HEMS had an odds ratio (OR) for survival of 6.9 compared with ground transport.ConclusionsImplementation of a PS-HEMS was associated with significant reduction in time to the trauma centre for severely injured patients. We also observed significantly reduced proportions of secondary transfers and 30-day mortality.

Are severely injured trauma victims in Norway offered advanced pre‐hospital care? National, retrospective, observational cohort

“…In a mature system, build on a belief that a survival benefit of the service is expected, we had expected better precision in dispatch or better availability. The findings are in line with a recent study from Denmark 12. Another recent study comparing the trauma centre in Oslo, Norway to the trauma centre in Stockholm, Sweden found an 8.2 times higher presence of pre‐hospital anaesthesiologists in Oslo (30.5%) as compared to Stockholm (3.7%) 13.…”

“…Additionally, other benefits such as reduced need for secondary transfer and reduced mortality rates can be seen 12. However, due to the cost, limited availability of HEMS, and non‐negligible risk for both the crew and the patient, there is a growing focus on limiting over‐triage 15, 17, 18, 19, 20.…”

The Impact of Helicopter Emergency Medical Service Night Operations in South East England

“…Previous studies 7,8 have shown a similar demographic of a higher proportion of road traffic collisions occurring by night and also assaults. These assault victims may suffer blunt or penetrating trauma that may require enhanced medical care.…”

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

“…Advanced treatment was provided in more than two thirds of these missions, which cannot be expected from ambulance personnel or regular GPs. Indeed, many patients with serious conditions and a high rate of providing advanced medical treatment may indicate the need for an anesthesiologist or at least a physician well‐trained in emergency medicine; however, the benefit of physician‐staffed HEMS has been debated for decades 9, 13, 15, 21, 22. In addition, the advantage of an experienced anesthesiologist capable of early and sound clinical judgment may be of more value than performing advanced interventions, as the avoidance of an intervention is best practice in some cases.…”