Beneficial effect of helicopter emergency medical services on survival of severely injured patients

Frankema, Sander P.G.; Ringburg, A.N.; Steyerberg, Ewout W.; Edwards, Michael J.; Schipper, I.B.; Vugt, A.B. van

doi:10.1002/bjs.4756

Cited by 113 publications

(73 citation statements)

References 26 publications

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“…Frankema et al 26 found that after adjustment for injury severity, time of day, and other physiological variables, transportation of a highly trained medical crew to the scene was associated with a nonstatistically significant difference in survival (OR, 2.2; 95% CI, 0.92-5.9; P =.08). Blunt trauma patients transported by helicopter in the study by Frankema et al had a statistically significant survival improvement (OR, 2.8; 95% CI, 1.07-7.52; P=.04).…”

Section: Commentmentioning

confidence: 99%

Association Between Helicopter vs Ground Emergency Medical Services and Survival for Adults With Major Trauma

Galvagno¹,

Haut²,

Zafar³

et al. 2013

Survey of Anesthesiology

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Context-Helicopter emergency medical services and their possible effect on outcomes for traumatically injured patients remain a subject of debate. Because helicopter services are a limited and expensive resource, a methodologically rigorous investigation of its effectiveness compared with ground emergency medical services is warranted.Objective-To assess the association between the use of helicopter vs ground services and survival among adults with serious traumatic injuries. Online-Only Material:The eFigure, eTables 1-3, and the Author Video Interview are available at http://www.jama.com.Author Contributions: Dr Galvagno had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Galvagno, Haut, Millin, Efron, Koenig, Pronovost, Haider. Acquisition of data: Galvagno, Haut, Zafar, Haider. Analysis and interpretation of data: Galvagno, Zafar, Baker, Bowman, Haider. Drafting of the manuscript: Galvagno, Haut, Milllin, Efron, Baker, Bowman, Pronovost, Haider. Critical revision of the manuscript for important intellectual content: Galvagno, Koenig, Baker, Bowman, Pronovost, Haider. Statistical expertise: Galvagno, Zafar, Bowman, Haider.Administrative, technical, or material support: Galvagno, Haut, Efron, Pronovost, Haider. Study supervision: Galvagno, Haut, Haider. Conclusion-Among patients with major trauma admitted to level I or level II trauma centers, transport by helicopter compared with ground services was associated with improved survival to hospital discharge after controlling for multiple known confounders. NIH Public AccessTrauma remains the leading cause of death and disability among young people around the world. In the United States, more than 50 million people are injured per year, resulting in approximately 169 000 annual deaths and a lifetime cost of $406 billion. 1,2Over the past several years, significant improvements in survival after trauma have been achieved. One reason for this has been improvements in emergency medical services (EMS) and life-saving transport of trauma patients to a center capable of providing definitive care. The utility of helicopter EMS and its possible effect on outcomes for traumatically injured patients remains the subject of debate. [3][4][5][6][7][8] Because helicopter transport is a limited and expensive resource, a methodologically rigorous investigation of its effectiveness compared with ground EMS is warranted.Several studies have used the National Trauma Data Bank (NTDB) to assess outcomes for traumatically injured adultstransportedbyeitheroption. [9][10][11] Although each of these studies concluded that helicopter transport was associated with improved odds of survival, they also reported limitations to their conclusions because of the lack of testing for the assumptions of a regression model, and none was able to account for the differences in how patients were assigned treatments (helicopter or ground transport). Additionally, the high proportio...

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Section: Commentmentioning

confidence: 99%

Association Between Helicopter vs Ground Emergency Medical Services and Survival for Adults With Major Trauma

Galvagno¹,

Haut²,

Zafar³

et al. 2013

Survey of Anesthesiology

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“…The reason for this is that there has never been designed a prospective randomized study to assess the usefulness of physician-staffed prehospital trauma teams. Though, several retrospective studies indicated that the MMT in the Netherlands offers an increased chance of survival for severely injured patients and could lead to reduced morbidity [8][9][10]. In studies conducted among prehospital traumatic deaths, airway management has been shown the key in preventable deaths in patients with severe head injury [11,12].…”

Section: Discussionmentioning

confidence: 99%

Cancellations of (helicopter transported) – Mobile Medical Team dispatches in the Netherlands

2010

TVTR

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Background The trauma centre of the Trauma Center Region North-West Netherlands (TRNWN) has consensus criteria for Mobile Medical Team (MMT) scene dispatch. The MMT can be dispatched by the EMS-dispatch centre or by the on-scene ambulance crew and is transported by helicopter or ground transport. Although much attention has been paid to improve the dispatch criteria, the MMT is often cancelled after being dispatched. The aim of this study was to assess the cancellation rate and the noncompliant dispatches of our MMT and to identify factors associated with this form of primary overtriage. Methods By retrospective analysis of all MMT dispatches in the period from 1 July 2006 till 31 December 2006 using chart review, we conducted a consecutive case review of 605 dispatches. Four hundred and sixty seven of these were included for our study, collecting data related to prehospital triage, patient's condition on-scene and hospital course. Results Average age was 35.9 years; the majority of the patients were male (65.3%). Four hundred and thirty patients were victims of trauma, sustaining injuries in most cases from blunt trauma (89.3%). After being dispatched, the MMT was cancelled 203 times (43.5%). Statistically significant differences between assists and cancellations were found for overall mortality, mean RTS, GCS and ISS, mean hospitalization, length and amount of ICU admissions (p<0.001). All dispatches were evaluated by using the MMT-dispatch criteria and mission appropriateness criteria. Almost 26% of all dispatches were neither appropriate, nor met the dispatch criteria. Fourteen missions were appropriate, but did not meet the dispatch criteria. The remaining 318 dispatches had met the dispatch criteria, of which 135 Surg (2010) 395:737-745 DOI 10.1007 (30.3%) were also appropriate. The calculated additional costs of the cancelled dispatches summed up to a total of € 34,448, amounting to 2.2% of the total MMT costs during the study period. Conclusion In our trauma system, the MMT dispatches are involved with high rates of overtriage. After being dispatched, the MMT is cancelled in almost 50% of all cases. We found an undertriage rate of 4%, which we think is acceptable. All cancellations were justified. The additional costs of the cancelled missions were within an acceptable range. According to this study, it seems to be possible to reduce the overtriage rate of the MMT dispatches, without increasing the undertriage rate to nonacceptable levels.

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“…Accurate triage and bypass protocols (whereby patients with major trauma are taken directly to a major trauma centre, potentially bypassing closer EDs) are therefore essential [3,46,67,68]. Helicopter transfer to definitive care has recently been demonstrated to reduce mortality from major trauma [69], but this is in addition to evidence that physicians bring survival benefits to the pre-hospital phase of trauma care [70,71].…”

Section: Pre-hospital Carementioning

confidence: 99%

Trauma system development

Lendrum

Lockey

2012

Anaesthesia

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SummaryThe word ‘trauma’ describes the disease entity resulting from physical injury. Trauma is one of the leading causes of death worldwide and deaths due to injury look set to increase. As early as the 1970s, it became evident that centralisation of resources and expertise could reduce the mortality rate from serious injury and that organisation of trauma care delivery into formal systems could improve outcome further. Internationally, trauma systems have evolved in various forms, with widespread reports of mortality and functional outcome benefits when major trauma management is delivered in this way. The management of major trauma in England is currently undergoing significant change. The London Trauma System began operating in April 2010 and others throughout England became operational this year. Similar systems exist internationally and continue to be developed. Anaesthetists have been and continue to be involved with all levels of trauma care delivery, from the provision of pre‐hospital trauma and retrieval teams, through to chronic pain management and rehabilitation of patients back into society. This review examines the international development of major trauma care delivery and the components of a modern trauma system.

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Beneficial effect of helicopter emergency medical services on survival of severely injured patients

Abstract: The presence of the HMT may increase chances of survival for patients suffering multiple trauma, especially for those with blunt trauma.

Cited by 113 publications

References 26 publications

Association Between Helicopter vs Ground Emergency Medical Services and Survival for Adults With Major Trauma

Association Between Helicopter vs Ground Emergency Medical Services and Survival for Adults With Major Trauma

Cancellations of (helicopter transported) – Mobile Medical Team dispatches in the Netherlands

Trauma system development

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