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

Black, John J.; Ward, Matthew; Lockey, David

doi:10.1136/emj.2002.004473

Cited by 41 publications

(24 citation statements)

References 52 publications

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“…These include hazardous environmental conditions (such as fog or high winds), aggressive or uncooperative patients and patients who have been contaminated with chemicals which may compromise safety by incapacitating helicopter pilots. 17 There are also relative contra-indications to helicopter transfer which include any degree of airway difficulty or obstruction as the loss of an airway on board the helicopter is both difficult to recognise and to treat. 17 Accepting that there are some limitations to the use of helicopter ambulances, the issues of cost effectiveness are still not resolved.…”

Section: Discussionmentioning

confidence: 99%

Helicopter Emergency Ambulance Service (HEAS) Transfer: An Analysis of Trauma Patient Case-Mix, Injury Severity and Outcome

Melton

Jain

Kendrick

et al. 2007

annals

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Ann R Coll Surg Engl 2007; 89: [513][514][515][516] 513 Helicopters were used very successfully for the transfer of wounded soldiers from the battlefields in the Korean and Vietnam wars and this model of patient transfer was then put into use in a civilian setting, initially in the US. In 1987, the first helicopter-based ambulance service in the UK was introduced in the Greater London region. 1Although this service carries an emergency physician as crew, it is unique in that respect. All other 15 dedicated HEAS providers in the UK are usually manned by one pilot and two paramedics. Advanced trauma and life-support (ATLS) teaching is that there are three peaks of mortality following major trauma. An early peak is due to patients who will die immediately with fatal injuries, a second peak of patients who will die in the 60 min following trauma and a third peak representing patients who will die of delayed complications of their injuries such as organ failure and sepsis. The second peak of mortality within 60 min of injury (the so-called 'golden hour' in ATLS teaching) represents the patients for whom rapid transfer to an emergency medical care facility from the scene of injury is potentially life-saving. 3The perceived benefit of helicopter transfer is the faster speed of transfer to hospital. This will maximise the proportion of the 'golden hour' spent in a hospital setting where potentially reversible conditions such as tension pneumothorax or cardiac tamponade can be treated. The most commonly used helicopter for HEAS in the UK is the Eurocopter 'Bolkow' 105, 2 which has a maximum speed of 252 km/h, clearly faster than ground ambulance. However, when factors such as mobilisation time, weather conditions, ease of access and the availability of helipad for landing at destination hospitals is considered, quicker transfer by helicopter is not always guaranteed. Many studies have found that patient transfer by helicopter is often not faster than by ground ambulance transfer overall except when large distances (over 45 km) are involved or when roads are poor or traffic conditions bad. These studies have questioned which

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Section: Discussionmentioning

confidence: 99%

Helicopter Emergency Ambulance Service (HEAS) Transfer: An Analysis of Trauma Patient Case-Mix, Injury Severity and Outcome

Melton

Jain

Kendrick

et al. 2007

annals

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“…A helicopter can improve the range, and therefore efficiency, of a CCT, but the effect of patient transfer by helicopter over relatively short distances in urban and semi-rural settings in unknown. 33 In our study almost all patients attended by the CCT were conveyed to hospital by conventional land ambulance, suggesting that air transport of patients is not a factor that influences outcome in our setting.…”

Section: Discussionmentioning

confidence: 61%

The impact of a pre-hospital critical care team on survival from out-of-hospital cardiac arrest

2015

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The impact of a pre-hospital critical care team on survival from out-of-hospital cardiac arrest. Resuscitation, 96. pp. 290-295. ISSN 0300-9572 Available from: http://eprints.uwe.ac.uk/29457We recommend you cite the published version. The publisher's URL is: http://dx.doi.org/10.1016/j.resuscitation.2015.08.020Refereed: Yes (no note) Disclaimer UWE has obtained warranties from all depositors as to their title in the material deposited and as to their right to deposit such material. UWE makes no representation or warranties of commercial utility, title, or fitness for a particular purpose or any other warranty, express or implied in respect of any material deposited. UWE makes no representation that the use of the materials will not infringe any patent, copyright, trademark or other property or proprietary rights. UWE accepts no liability for any infringement of intellectual property rights in any material deposited but will remove such material from public view pending investigation in the event of an allegation of any such infringement. PLEASE SCROLL DOWN FOR TEXT.The Impact of a pre-hospital critical care team on survival from out of hospital cardiac arrest 1 THE IMPACT OF A PRE-HOSPITAL CRITICAL CARE TEAM ON SURVIVAL FROM OUT-OF- WORD COUNT, REFERENCES, FIGURES AND TABLES Abstract: 233Manuscript: 3045 ABSTRACT AimTo assess the impact of a pre-hospital critical care team (CCT) on survival from out-ofhospital cardiac arrest (OHCA). MethodsWe undertook a retrospective observational study, comparing OHCA patients attended by advanced life support (ALS) paramedics with OHCA patients attended by ALS paramedics and a CCT between April 2011 and April 2013 in a single ambulance service in Southwest England. We used multiple logistic regression to control for an anticipated imbalance of prognostic factors between the groups. The primary outcome was survival to hospital discharge. All data were collected independently of the research. Results1851 cases of OHCA were included in the analysis, of which 1686 received ALS paramedic treatment and 165 were attended by both ALS paramedics and a CCT. Unadjusted rates of survival to hospital discharge were significantly higher in the CCT group, compared to the ALS paramedic group (15.8% and 6.5%, respectively, p < 0.001). After adjustment using multiple logistic regression, the effect of CCT treatment was no longer statistically significant (OR 1.54, 95% CI 0.89 to 2.67, p = 0.13). Subgroup analysis of OHCA with first monitored rhythm of ventricular fibrillation or pulseless ventricular tachycardia showed similar results. ConclusionPre-hospital critical care for OHCA was not associated with significantly improved rates of survival to hospital discharge. These results are in keeping with previously published studies.Further research with a larger sample size is required to determine whether CCTs can improve outcome in OHCA.The Impact of a pre-hospital critical care team on survival from out of hospital cardiac arrest 3

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“…28 Many laudable attempts to streamline prehospital trauma triage have attempted to identify anatomic, physiologic, or situational components that identify patients appropriate for advanced trauma care without resulting in substantial overtriage. [29][30][31] Reliance on physiologic criteria/vital signs alone, for instance, will likely result in unacceptable levels of undertriage, as patients with significant injuries may have normal vital signs at the scene. 32,33 The same concerns apply to triage decisions based solely on anatomic or situational factors.…”

Section: Use Of the Cdc 2011 Guidelines For The Field Triage Of Injurmentioning

confidence: 99%

“…53 A review panel led by Black selected decreased level of consciousness (LOC), airway obstruction, respiratory distress, shock, and significant head injury as the clinical features that should prompt HEMS activation. 29 In a database review, Giannakopoulos et al isolated anatomic, physiologic, and mechanistic criteria that warranted the most timely transportation possible to a trauma center. 38 Moront et al determined that in pediatric trauma, the combination of GCS < 12 and HR > 160 yielded a 99% sensitivity and 90% specificity for major trauma, although there were limitations in the study.…”

Section: Helicopter Transportation For Patients Meeting Physiologic Amentioning

confidence: 99%

“…11,[19][20][21][22][23][24][25][26][27] This EBG builds off the CDC criteria as a starting point in the triage process, then elaborates on the circumstances in which ground and air medical transport might best be used. The decision-making surrounding transport modality is inextricably linked to the data informing trauma triage, since patients at higher risk of injury are more time-sensitive cases for which advanced intervention and transport to highlevel trauma care is often achievable only via HEMS.…”

Section: Use Of the Cdc 2011 Guidelines For The Field Triage Of Injurmentioning

confidence: 99%

See 1 more Smart Citation

An Evidence-based Guideline for the Air Medical Transportation of Prehospital Trauma Patients

Thomas¹,

Brown²,

Oliver³

et al. 2013

Prehospital Emergency Care

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Background. Decisions about the transportation of trauma patients by helicopter are often not well informed by research assessing the risks, benefits, and costs of such transport. Objective. The objective of this evidence-based guideline (EBG) is to recommend a strategy for the selection of prehospital trauma patients who would benefit most from aeromedical transportation. Methods. A multidisciplinary panel was recruited consisting of experts in trauma, EBG development, and emergency medical services (EMS) outcomes research. Representatives of the Federal Interagency Committee on Emergency Medical Services (FICEMS), the National Highway Traffic Safety Administration (NHTSA) (funding agency), and the Children's National Medical Center (investigative team) also contributed to the process. The panel used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology to guide question formulation, evidence retrieval, appraisal/synthesis, and formulate recommendations. The process followed the National Evidence-Based Guideline Model Process, which has been approved by the Federal Interagency Committee on

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

Cited by 41 publications

References 52 publications

Helicopter Emergency Ambulance Service (HEAS) Transfer: An Analysis of Trauma Patient Case-Mix, Injury Severity and Outcome

Helicopter Emergency Ambulance Service (HEAS) Transfer: An Analysis of Trauma Patient Case-Mix, Injury Severity and Outcome

The impact of a pre-hospital critical care team on survival from out-of-hospital cardiac arrest

An Evidence-based Guideline for the Air Medical Transportation of Prehospital Trauma Patients

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