The contribution of helicopter emergency medical services in the pre-hospital care of penetrating torso injuries in a semi-rural setting

Abstract

Background Although the merit of pre-hospital critical care teams such as Helicopter Emergency Medical Services (HEMS) has been universally recognized for patients with penetrating torso injuries who present with unstable physiology, the potential merit in patients initially presenting with stable physiology is largely undetermined. The ability to predict the required pre-hospital interventions patients may have important implications for HEMS tasking, especially when transport times to definitive care are prolonged. Methods We performed a retrospective cohort study of patients who sustained a penetrating torso injury and were attended by the Air Ambulance Kent Surrey Sussex (AAKSS) over a 6-year period. Primary outcome was defined as the percentage of patients with penetrating torso injuries requiring HEMS-specific interventions anytime between HEMS arrival and arrival at hospital. Secondary outcomes were the association of individual patient- and injury characteristics with the requirement for HEMS interventions. Results During the study period 363 patients met inclusion criteria. 90% of patients were male with a median age of 30 years. 99% of penetrating trauma incident occurred more than 10-min drive from a Major Trauma Centre (MTC). Presenting GCS was > 13 in 83% of patients. Significant hemodynamic- or ventilatory compromise was present in more than 25% of the patients. Traumatic cardiac arrest was present in 34 patients (9.4%), profound hypotension with SBP < 80 mmHg in 30 (8.3%) and oxygen saturations < 92% in 30 (8.3%). A total of 121 HEMS-specific interventions were performed. Although HEMS-specific interventions were associated with presenting physiology (TCA OR 1.75 [1.41–2.16], SBP < 80 mmHg (OR 1.40 [1.18–1.67] and SpO2 < 92% (OR 1.39 [1.17–1.65], a minority of the patients presented initially with stable physiology but deteriorated on route to hospital and required HEMS interventions (n = 9, 3.3%). Conclusion HEMS teams provide potentially important contribution to the pre-hospital treatment of patients with penetrating torso injuries in rural and semi-rural areas, especially when they present with unstable physiology. A certain degree of over-triage is inevitable in these patients, as it is hard to predict which patients will deteriorate on route to hospital and will need HEMS interventions. The results of this study showing a potentially predictable geographical dispersion of penetrating trauma could inform multi-agency knife crime prevention strategy.

Demographics and Patterns of Injury in Patients with Sharp Penetrating Trauma admitted to a Greater Manchester Major Trauma Centre: A Retrospective Five-Year Study

“…Gender and Age: Young males are most likely to be victim of violent crimes involving knives according to the majority of published data [15][16][17][18][19][20][21][22][23][24][25][26][27]. A 2017 systematic review by Whittaker et Al.…”

“…Gavrilovski et Al. [27] have demonstrated that violence involving knives is increasing outside of urban centres and may be linked to the creation of so called "county lines" [28]. This implicates that SPT is frequently drug related, either through distribution or consumption.…”

Implementation of a low-titre whole blood transfusion program in a civilian helicopter emergency medical service

“…The decision to initiate transfusion in a patient with suspected haemorrhagic shock is both complex and time-critical and is based on a variety of symptoms, clinical presentations and mechanisms of injury. In patients presenting with unstable physiology or clinical signs on scene, a certain degree of overtransfusion may be inevitable [27]. Although increased survival to hospital in trauma patients receiving out of hospital transfusion of PRBC has been shown, this does not necessarily translate into increased long-term survival [28].…”