Impact of Helicopter Emergency Medical Service in Traumatized Patients: Which Patient Benefits Most?

Andruszkow, Hagen; Schweigkofler, Uwe; Lefering, Rolf; Frey, Magnus; Horst, Klemens; Pfeifer, Roman; Beckers, Stefan; Pape, Hans-Christian; Hildebrand, Frank

doi:10.1371/journal.pone.0146897

Cited by 56 publications

(37 citation statements)

References 44 publications

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“…Severe chest trauma has been identified as one of the most frequent injury patterns, in addition to being a crucial prognostic factor and a leading cause of death after trauma [1]. Recent studies revealed extended periods of mechanical ventilation and length of ICU stay for severely injured patients with thoracic injuries [3]. Furthermore, severe chest trauma has been shown to be associated with the development of diverse complications (e.g., multiple organ dysfunction syndrome (MODS) and an increase of mortality by approximately 25% considering all trauma-related deaths) [3,4].…”

Section: Introductionmentioning

confidence: 99%

Impact of Chest Trauma and Overweight on Mortality and Outcome in Severely Injured Patients

Eckhardt

Horst

Störmann

et al. 2020

JCM

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The morbidity and mortality of severely injured patients are commonly affected by multiple factors. Especially, severe chest trauma has been shown to be a significant factor in considering outcome. Contemporaneously, weight-associated endocrinological, haematological, and metabolic deviations from the norm seem to have an impact on the posttraumatic course. Therefore, the aim of this study was to determine the influence of body weight on severely injured patients by emphasizing chest trauma. A total of 338 severely injured patients were included. Multivariate regression analyses were performed on patients with severe chest trauma (AIS ≥ 3) and patients with minor chest trauma (AIS < 3). The influence of body weight on in-hospital mortality was evaluated. Of all the patients, 70.4% were male, the median age was 52 years (IQR 36–68), the overall Injury Severity Score (ISS) was 24 points (IQR 17–29), and a median BMI of 25.1 points (IQR 23–28) was determined. In general, chest trauma was associated with prolonged ventilation, prolonged ICU treatment, and increased mortality. For overweight patients with severe chest trauma, an independent survival benefit was found (OR 0.158; p = 0.037). Overweight seems to have an impact on the mortality of severely injured patients with combined chest trauma. Potentially, a nutritive advantage or still-unknown immunological aspects in these patients affecting the intensive treatment course could be argued.

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Section: Introductionmentioning

confidence: 99%

Impact of Chest Trauma and Overweight on Mortality and Outcome in Severely Injured Patients

Eckhardt

Horst

Störmann

et al. 2020

JCM

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“…Prehospital trauma management is still a controversial issue with inconsistent evidence comparing the effects of helicopter and ground emergency transport on the results of severe trauma patients. In study from Andruszkow et al, 2) the HEMS transport had a significant survival advantage compared to ground transport although high severity of trauma and high post-treatment complication including multiple organ dysfunction syndrome (MODS: acute kidney injury, pneumonia, hepatic failure, traumatic coagulopathy etc.) or severe sepsis.…”

Section: Discussionmentioning

confidence: 99%

Treatment Experiences of Traumatic Brain Injury Patients using Doctor-Helicopter Emergency Medical Service: Early Data in a Regional Trauma Center

Kim

Yun

2020

Korean J Neurotrauma

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Objective The purpose of this study is to analyze the results of doctor helicopter emergency medical service (HEMS) in traumatic brain injury (TBI) patients and to understand the effect and improvement of doctor HEMS. Methods We included TBI patients transferred by doctor HEMS of our hospital between February 2016 and December 2017. Basic characteristics, HEMS data, treatment and results data were analyzed retrospectively. We divided the patients into 3 groups as regarding severity of patient, relevance of treatment and transfer. We investigated the preventable trauma death rate (PTDR) of these groups to increase the reliability of the treatment outcome. Results TBI patients using doctor HEMS were indicated in 98 patients (18.7%) among 522 overall HEMS patients. The overall mortality was consisted in 21.4% and 43.2% was resulted in Glasgow outcome scale 4 or 5. The group of proper transport and treatment for severe TBI was consisted in 62.2% including 13 mortality cases and no preventable death. The group of delayed transport or treatment for severe TBI was 18.3% including 8 mortality cases and 1 preventable death. The PTDR of TBI after doctor HEMS was significantly lower than that of overall TBI (4.8% vs. 11.6%, p =0.045). Conclusion In patients with severe TBI, doctor HEMS can improve treatment outcomes by reducing treatment delay and unnecessary examinations and this result was evidenced that the PTDR were decreased significantly after doctor HEMS transport. The appropriate treatment is mandatory for real-time communication with the emergency doctor and treatment preparation of the trauma team during the HEMS transport.

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“…HEMS authorisation cannot be restricted to a pre-defined list of clinical conditions or injuries, and an exhaustive list can therefore not be provided within the SAHAS. Other comorbidities should also be considered [32] . In keeping with the views of our panel, the importance of appropriate selection of CMOs cannot be over-emphasised.…”

Section: Discussionmentioning

confidence: 99%

Developing a South African Helicopter Emergency Medical Service Activation Screen (SAHAS): A Delphi study

Laatz

Welzel

Stassen

2019

African Journal of Emergency Medicine

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Introduction Helicopter Emergency Medical Services (HEMS) are an expensive resource that should be utilised efficiently to optimise the cost-benefit ratio. This is especially true in resource-limited settings, such as South Africa. This may be achieved by implementing call-out criteria that are most appropriate to the healthcare system in which HEMS operate. Currently, there are no published evidence-based HEMS call-out criteria developed for South Africa. By identifying patients that are most likely to benefit from HEMS, their utilisation can be enhanced and adjusted to ensure optimal patient outcome. We aimed to systematically utilise expert opinions to reach consensus on HEMS call-out criteria that are contextual to the South African setting. Methods A modified Delphi technique was used to develop call-out criteria, using current literature as the basis of the study. Purposive, snowball sampling was employed to identify a sample of 118 participants locally and internationally, of which 42 participated for all three rounds. Using an online survey platform, binary agreement/disagreement with each criterion was sought. Acceptable consensus was set at 75%. Statements were sent out in the third round ascertaining whether participants agreed with the analysis of the first two rounds. Results After two rounds, consensus was obtained for 63% (36/57) of criteria, while 64% of generated statements received consensus in the third round. Results emphasised the opinion that HEMS dispatch criteria relating to patient condition and incident locations were preferential to a comprehensive list. Through collation of these results and international literature, we present an initial concept for a South African HEMS Activation Screen (SAHAS), favouring inquiry on a case-by-case basis. Discussion The combination of existing literature and participant opinions, established that call-out criteria are most efficient when based on clinical parameters and geographic considerations, as opposed to a specified list of criteria. The initial concept of our SAHAS should be investigated further.

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Impact of Helicopter Emergency Medical Service in Traumatized Patients: Which Patient Benefits Most?

Cited by 56 publications

References 44 publications

Impact of Chest Trauma and Overweight on Mortality and Outcome in Severely Injured Patients

Impact of Chest Trauma and Overweight on Mortality and Outcome in Severely Injured Patients

Treatment Experiences of Traumatic Brain Injury Patients using Doctor-Helicopter Emergency Medical Service: Early Data in a Regional Trauma Center

Developing a South African Helicopter Emergency Medical Service Activation Screen (SAHAS): A Delphi study

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