Reducing Time to Urgent Surgery by Transporting Resources to the Trauma Patient

McMonagle, Morgan; Flabouris, Arthas; Parr, Michael; Sugrue, Michael

doi:10.1111/j.1445-2197.2007.04026.x

Cited by 9 publications

(4 citation statements)

References 34 publications

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“…McMonagle et al reviewed trauma patients transported by the air retrieval service in NSW between 1999 and 2003. 9 There were 749 interhospital patient transfers, of which 64% were from rural areas. However, only 0.4% (3) patients had a surgically supported response with an urgent surgical procedure carried out before patient transportation, which did not provide enough power to conclude whether such a surgically supported retrieval response would be cost effective.…”

Section: Discussionmentioning

confidence: 99%

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Is neurotrauma training in rural New South Wales still required following the implementation of the New South Wales State Trauma Plan?

Vessey

Shivapathasundram

Francis

et al. 2021

ANZ Journal of Surgery

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Background: In New South Wales (NSW), Australia, trauma accounts for 6% of deaths. Trauma patients receiving definitive care in regional trauma centres are 34% more likely to have a fatal outcome compared to level 1 centres. Following the implementation of the NSW State Trauma Plan where patients with major trauma are fast tracked to regional trauma services, should NSW rural surgeons and retrieval doctors continue to receive surgical training in neurotrauma? Methods: The study's primary objective was to ascertain which NSW regional and rural hospitals have the equipment to perform neurotrauma and when it was last used. The study also examined the outcome of those patients who had undergone an emergency neurosurgical procedure. Results: Of the 149 regional and rural hospitals in NSW, 16 stored a Hudson brace, perforator, burr and Gigli saw sterile and ready to use in the operating theatre. Only one hospital utilised the equipment in the last year and 11 in the last 10 years. Of those patients who had undergone an emergency neurosurgical procedure, two patients died prior to transfer and three were confirmed deceased after transfer to a tertiary centre. Conclusion:The implementation of the NSW State Trauma Plan has streamlined the trauma triage process and transport of neurotrauma patients to regional and major trauma services. However, it is likely that knowledge of how to perform burr hole and craniectomy for the evacuation of extradural haematoma remains a useful skill for the rural surgeon and retrieval doctor if transport is delayed.

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Section: Discussionmentioning

confidence: 99%

“…Of interest was the ability of the neurosurgery team to be in attendance in an emergency on‐the‐spot operation. McMonagle et al reviewed trauma patients transported by the air retrieval service in NSW between 1999 and 2003 9 . There were 749 interhospital patient transfers, of which 64% were from rural areas.…”

Section: Discussionmentioning

confidence: 99%

Is neurotrauma training in rural New South Wales still required following the implementation of the New South Wales State Trauma Plan?

Vessey

Shivapathasundram

Francis

et al. 2021

ANZ Journal of Surgery

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“…Time to definitive trauma care (particularly hemostasis requiring surgery) is known to strongly influence outcome [12]. In a previous study, researchers suggested a road distance more than 10 miles or an expected transport time more than 45 minutes by GEMS is the minimum at which helicopter transport could be faster [13].…”

Section: Discussionmentioning

confidence: 99%

Association between helicopter with physician versus ground emergency medical services and survival of adults with major trauma in Japan

et al. 2014

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IntroductionHelicopter emergency medical services with a physician (HEMS) has been provided in Japan since 2001. However, HEMS and its possible effect on outcomes for severe trauma patients have still been debated as helicopter services require expensive and limited resources. Our aim was to analyze the association between the use of helicopters with a physician versus ground services and survival among adults with serious traumatic injuries.MethodsThis multicenter prospective observational study involved 24,293 patients. All patients were older than 15 years of age, had sustained blunt or penetrating trauma and had an Injury Severity Score (ISS) higher than 15. All of the patient data were recorded between 2004 and 2011 in the Japan Trauma Data Bank, which includes data from 114 major emergency hospitals in Japan. The primary outcome was survival to discharge from hospitals. The intervention was either transport by helicopter with a physician or ground emergency services.ResultsA total of 2,090 patients in the sample were transported by helicopter, and 22,203 were transported by ground. Overall, 546 patients (26.1%) transported by helicopter died compared to 5,765 patients (26.0%) transported by ground emergency services. Patients transported by helicopter had higher ISSs than those transported by ground. In multivariable logistic regression, helicopter transport had an odds ratio (OR) for survival to discharge of 1.277 (95% confidence interval (CI), 1.049 to 1.556) after adjusting for age, sex, mechanism of injury, type of trauma, initial vital signs (including systolic blood pressure, heart rate and respiratory rate), ISS and prehospital treatment (including intubation, airway protection maneuver and intravenous fluid). In the propensity score–matched cohort, helicopter transport was associated with improved odds of survival compared to ground transport (OR, 1.446; 95% CI, 1.220 to 1.714). In conditional logistic regression, after adjusting for prehospital treatment (including intubation, airway protection maneuver and intravenous fluid), similar positive associations were observed (OR, 1.230; 95% CI, 1.017 to 1.488).ConclusionsAmong patients with major trauma in Japan, transport by helicopter with a physician may be associated with improved survival to hospital discharge compared to ground emergency services after controlling for multiple known confounders.

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“…The time to definitive trauma care strongly influences patient outcomes. 31 Any benefit associated with HEMS would likely be attributed to a reduction in the time from injury to definitive care. However, in this study, the median time from 119 is Japanese version calls to ED arrival was longer in the helicopter than in the ground group.…”

Section: Discussionmentioning

confidence: 99%

Association of Pre-Hospital Helicopter Transport with Reduced Mortality in Traumatic Brain Injury in Japan: A Nationwide Retrospective Cohort Study

Hosomi

Kitamura

Sobue

et al. 2022

Journal of Neurotrauma

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Patients with traumatic brain injury (TBI) are severely injured patients who require timely, efficient, and specialized care. The effectiveness of helicopter emergency medical services (HEMS) for patients with TBI remains unclear. This study aimed to compare the mortality of patients with TBI transported by HEMS and ground ambulance using propensity score-matching analysis, and to analyze the effects of HEMS in various subpopulations. We conducted a retrospective analysis of the Japan Trauma Data Bank. The study period was from January 2004 to December 2018. The participants were divided into two groups: the helicopter group (patients transported by HEMS) and ground group (patients transported by ground ambulance). The principal outcome was death at hospital discharge. In total, 58,532 patients were eligible for analysis (ground group, n = 54,820 [93.7%]; helicopter group, n = 3712 [6.3%]). Helicopter transport decreased patient mortality at hospital discharge (adjusted odds ratio [OR], 0.83; 95% confidence interval [CI], 0.74–0.92). In propensity score-matched patients, the proportion of deaths at hospital discharge was lower in the helicopter (18.76%) than in the ground (21.21%) group (crude OR, 0.86; 95% CI, 0.77–0.96). The mortality rate in the helicopter group was significantly reduced in many subpopulations, especially in cases of severe TBI with a decreased level of consciousness or higher Injury Severity Score (ISS; Japan Coma Scale score 2 [adjusted OR, 0.60; 95% CI, 0.45–0.80] and ISS ≥50 [adjusted OR, 0.69; 95% CI, 0.48–0.99]). Although the study design was non-randomized, our findings in patients with TBI showed that HEMS conferred a mortality benefit over ground ambulance.

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Reducing Time to Urgent Surgery by Transporting Resources to the Trauma Patient

Abstract: A surgically supported retrieval response allows for the more timely delivery of urgent surgical care. Patients can potentially benefit from such a response. There are, however, important operational considerations in providing a surgically supported retrieval response.

Cited by 9 publications

References 34 publications

Is neurotrauma training in rural New South Wales still required following the implementation of the New South Wales State Trauma Plan?

Is neurotrauma training in rural New South Wales still required following the implementation of the New South Wales State Trauma Plan?

Association between helicopter with physician versus ground emergency medical services and survival of adults with major trauma in Japan

Association of Pre-Hospital Helicopter Transport with Reduced Mortality in Traumatic Brain Injury in Japan: A Nationwide Retrospective Cohort Study

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