Outcome after severe head injury treated by an integrated trauma system.

Abstract

Emerg Med 1999;16:182-185)

Appropriate use of helicopters to transport trauma patients from incident scene to hospital in the United Kingdom: an algorithm

“…These patients should be anaesthetised, intubated, and ventilated if transported by helicopter. 14 The risk of vomiting is increased in the presence of a skull fracture, direct brain stem injury associated with raised intracranial pressure, and intracranial haematoma. Comatose head injured patients (AVPU score P or U, GCS ,9) may also be unable to maintain and protect their airways and this is itself an indication for RSI and tracheal intubation.…”

“…Flight crew configurations and the range of prehospital critical care skills available vary in different prehospital care systems. There is conflicting evidence in the literature as to which incident type and what flight crew combination (for example, paramedic 51 or nurse 52 alone, paramedic-paramedic, 53 paramedic-doctor, 14 54-66 paramedic-nurse, 34 58 67 68 70 71 nurse-doctor, 52 58 69 72 and nursenurse 67 68 ) are best suited to deliver this level of care in the field. A number of different outcomes (for example, patient mortality, critical care procedures undertaken, duration of stay in hospital/ITU) have been used in an attempt to assess this important issue, and all available studies have important limitations.…”

Comparison of Mortality Following Hospitalisation for Isolated Head Injury in England and Wales, and Victoria, Australia

“…Although TBI has been termed an “untreatable” predictor of mortality [1] , advances in trauma care systems, pre-hospital care, and critical care have led to improvements in patient survival following TBI. There is evidence to suggest that integration of trauma services [2] , [3] , [4] , direct transport of patients from the scene to hospital [5] , and the level of pre-hospital care can impact on TBI patient survival [6] .…”

Performance measurement in British Helicopter Emergency Medical Services and Australian Air Medical Services

“…The quality of a system is improved by continuous feedback of useful outcome measures 18. The evolution of intensive care and trauma systems has been assisted by the existence of an accurate feedback loop 28. Neither Australia nor the UK has a structure for sharing a comparative dataset, although there are plans to remedy this in both regions with the establishment of UKHEMS and ‘National Retrieval Directors’ in Australia 29.…”