Pre-hospital emergency anaesthesia in the United Kingdom: an observational cohort study

Abstract

Background: Up to one in eight trauma patients arrive at a hospital with a partially or completely obstructed airway. The UK National Institute for health and Care Excellence (NICE) practice guidelines recommend that trauma patients requiring anaesthesia for definitive airway management receive this care within 45 min of an emergency call, preferably at the incident scene. How frequently this target is achieved remains unclear. We assessed the recorded time to prehospital emergency anaesthesia after trauma across UK helicopter emergency medical service (HEMS) units. Methods: We retrospectively recorded time to pre-hospital emergency anaesthesia across all 20 eligible UK HEMS units (comprising 52 enhanced care teams) from April 1, 2017 to March 31, 2018. Times recorded for emergency notification, dispatch, arrival, and neuromuscular blocking agent administration were analysed. Results: HEMS undertook 1755 pre-hospital emergency anaesthetics for trauma across the UK during the study period. There were 1176/1755 (67%) episodes undertaken by helicopter response teams during daylight hours. The median time to pre-hospital emergency anaesthesia was 55 min (inter-quartile range: 45e70); anaesthesia within 45 min of the initial emergency call was achieved in 25% cases. Delayed dispatch time (>9 min) was associated with fewer patients receiving pre-hospital anaesthesia within 45 min (odds ratio: 7.7 [95% confidence intervals: 5.8e10.1]; P<0.0001). Conclusions: The time to achieve pre-hospital emergency anaesthesia by UK HEMS frequently exceeds the recommended 45 min target. Reducing the time to dispatch of emergency medical teams may impact on the delivery of prehospital emergency anaesthesia.

Pre‐hospital emergency anaesthesia in trauma patients: An observational study from a state‐wide Australian pre‐hospital and retrieval service

“…The NICE (UK) target of 45 min was set from first contact with emergency services. Therefore, previous literature on this topic has investigated the ‘time to team dispatch’ and the interaction between emergency service coordination and the PHRM teams at their disposal 12 . The time from first call to the activation of the PHRM team can vary slightly in SAAS practice.…”

Geo-temporal provision of pre-hospital emergency anaesthesia by UK Helicopter Emergency Medical Services: an observational cohort study

“…We only reviewed coverage of PHEA delivered by HEMS and failed to account for similar care that may be offered by other organisations. With regard to estimating the time to deliver PHEA, data from individual services were anonymised and combined before analysis, 13 resulting in the same median values being used for calculating coverage for all services. The median values used therefore do not take into account varying indications for intubation or other scene specifics such as entrapment or multiple casualties, which may lead to inaccurate estimation of at-scene times.…”

“…We used data recorded by 20 HEMS organisations on prehospital emergency anaesthesia performed after trauma over a 12 month period, as described in detail previously. 13 Study 2: prospective geo-temporal evaluation of provision of pre-hospital emergency anaesthesia…”

“…The details of contributing local investigators are included in the Organisation of UK Helicopter Emergency Medical Services in 2018 7 and 'Time to Pre-hospital Emergency Anaesthesia (TT-PHEA): A Review of National Helicopter Emergency Medical Service (HEMS) Performance' manuscripts. 13…”

Rapid sequence induction: where did the consensus go?

“…Within hospitals, there remains variation between speciality operating theatres, with obstetric theatres still reporting the highest use of a “traditional RSI” [ 6 ] among the relatively small numbers of patients receiving general anaesthesia for delivery. The concept of ‘critical care without walls’ – where key critical care interventions are delivered wherever required – has resulted in RSI frequently being performed outside the operating theatre in the emergency department (ED), intensive care unit (ICU) and in pre-hospital settings [ 12 , 13 ]. The frequently acknowledged challenges with anaesthesia outside the operating theatre include unfamiliar environments, teams, and equipment [ 14 ].…”