Helicopter Transport of Trauma Victims

Hamman, Baron L.; Cué, Jorge I.; Miller, Frank B.; O’Brien, Daniel C.; House, Todd; Polk, Hiram C.; Richardson, Jeannette

doi:10.1097/00005373-199104000-00007

Cited by 81 publications

(5 citation statements)

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“…Our results of CTs are consistent with the results of a previous meta-analysis which was reported in 2011 and ALS care was not associated with increased survival in trauma patients (32). The authors retrieved data from 9 trials including 16,857 patients that met their inclusion criteria (23,(25)(26)(27)(33)(34)(35)(36)(37) and included helicopter transportation. In the present study, we excluded helicopter transportation because resource was very limited, and it could affect results; tracheal intubation or chest compressions are difficult to perform in a flying helicopter.…”

Section: Discussionsupporting

confidence: 88%

Advanced Life Support vs. Basic Life Support for Patients With Trauma in Prehospital Settings: A Systematic Review and Meta-Analysis

et al. 2021

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Background: Advanced Life Support (ALS) is regarded to be associated with improved survival in pre-hospital trauma care when compared to Basic Life Support (BLS) irrespective of lack of evidence. The aim of this study is to ascertain ALS improves survival for trauma in prehospital settings when compared to BLS.Methods: We searched PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials for published controlled trials (CTs), and observational studies that were published until Aug 2017. The population of interest were adults (>18 years old) trauma patients who were transported by ground transportation and required resuscitation in prehospital settings. We compared outcomes between the ALS and BLS groups. The primary outcome was in-hospital mortality and secondary outcomes were neurological outcome and time spent on scene.Results: We identified 2,502 studies from various databases and 10 studies were included in the analysis (two CTs, and eight observational studies). The outcomes were not statistically significant between the ALS and BLS groups (pooled OR 1.14; 95% CI 0.95 to 1.36 for mortality, pooled OR 1.12; 95% CI 0.88 to 1.42 for good neurological outcomes, pooled mean difference −0.96; 95% CI−6.64 to 4.72 for on-scene time) in CTs. In observational studies, ALS prolonged on-scene time and increased mortality (pooled OR 1.56; 95% CI: 1.31 to 1.86 for mortality, and pooled mean difference, 1.26; 95% CI: 0.07 to 2.45 for on-scene time).Conclusions: In prehospital settings, the present study showed no advantages of ALS on the outcomes in patients with trauma compared to BLS.

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Section: Discussionsupporting

confidence: 88%

Advanced Life Support vs. Basic Life Support for Patients With Trauma in Prehospital Settings: A Systematic Review and Meta-Analysis

et al. 2021

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“…8 In primary trauma rescue missions, addition of trained physicians to the crew is associated with improved survival rates in some studies, 17,20,21 but not in others. 22 For IFT, only limited literature exists. In ST-elevation myocardial infarction, Gunnarsson et al 23 showed that patients transported by physician-staffed HEMS had a lower in-hospital adjusted adverse event risk compared with those transported by non-physician-staffed HEMS, although the in-hospital mortality did not differ between the groups.…”

Section: Discussionmentioning

confidence: 99%

“…However, the benefit of doctors in HEMS remains a subject of debate, 19 although the perceived patient and flight safety is higher when they are a part of the crew 8 . In primary trauma rescue missions, addition of trained physicians to the crew is associated with improved survival rates in some studies, 17 , 20 , 21 but not in others 22 . For IFT, only limited literature exists.…”

Section: Discussionmentioning

confidence: 99%

Predictors for in-flight medical interventions during helicopter interfacility transport in Hong Kong

Cheung

Lam

Fok³

et al. 2021

Hong Kong Journal of Emergency Medicine

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Introduction: Interfacility transport with helicopter from remote island clinics to urban hospitals account for a significant portion of the Hong Kong Government Flying Service missions. Currently, doctor and nurse escorts are deployed as volunteers only during the daytime from every Friday to Monday and on public holidays. While most transport runs smoothly, patient deterioration can occur during flight, warranting medical interventions on-board. Yet, little is known about the pattern and any clinical predictors of such interventions during helicopter interfacility transport missions. Methods: We collected Government Flying Service callout records from 1 January to 31 December 2016, and retrieved demographic, clinical and operational data. Interfacility transport mission was dispatched based on ‘Casualty Evacuation’ categories, which range from A+ (unstable), A (borderline) to B (stable). Univariate and multivariable logistic regression were used to identify independent predictors for in-flight medical interventions. Results: Of 1734 callout records, 386 interfacility transport missions escorted by volunteer doctors or nurses or both had complete flight medical records for analysis and 14.9% required in-flight medical interventions. Most interventions were related to oxygen therapy, intravenous fluid and administration of medications. Multivariable logistic regression showed that an age ⩾70 years, Casualty Evacuation A+ category, and any pre-flight emergency medical interventions were independent predictors for in-flight medical interventions. Conclusion: This study identified a few clinical predictors of in-flight medical interventions in an urban helicopter interfacility transport missions setting. Crewman training that focuses on the relevant procedural capabilities and clinical judgement is necessary to address the in-flight medical needs of interfacility transport missions.

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“…24 The case for airborne doctors is no clearer. 25 Detailed independent studies of the London HEMS helicopter comparing performance with standard care provided by ambulance staff only detected a small benefit in severely injured patients, with some evidence of detriment to those with less severe trauma. 26 However, the HEMS team identified additional potential benefit to those patients with intracranial haematomas who were given early advanced airway care as part of the trauma system built around the helicopter service.…”

Section: New Developments In Hong Kongmentioning

confidence: 99%

Reflections on Twenty Years of Prehospital Care

Cocks

2000

Hong Kong j. emerg. med.

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Although Accident and Emergency staff may feel that prehospital care is the province of the ambulance service alone, their interest in this area is important. Both A&E doctors and nurses have an important role to play in the training of paramedics, and in some circumstances in the direct provision of prehospital care. Physician involvement in routine prehospital care, whether by land or helicopter transport, is still controversial. This paper reviews some of the issues involved in prehospital care over the last twenty years, in addition to a personal perspective from the author. In the absence of a firm evidence base to lead the way to future development in Hong Kong, more research will be needed by doctors, nurses and ambulance staff.

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Helicopter Transport of Trauma Victims

Cited by 81 publications

References 0 publications

Advanced Life Support vs. Basic Life Support for Patients With Trauma in Prehospital Settings: A Systematic Review and Meta-Analysis

Advanced Life Support vs. Basic Life Support for Patients With Trauma in Prehospital Settings: A Systematic Review and Meta-Analysis

Predictors for in-flight medical interventions during helicopter interfacility transport in Hong Kong

Reflections on Twenty Years of Prehospital Care

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