Over‐Triage in Casevac Categorisation is Common in Hong Kong

Abstract

To review the categorisation of patients who were transferred out from outlying islands to urban hospitals utilising casualty evacuation (CASEVAC), and to search for possible patient characteristics which might have contributed to mis-categorisation during the 'non-flying' hours. Methods: The medical records of 459 patients, who were transferred out in the year 2009 were reviewed. Correctness of categorisation was determined by 2 independent assessors according to the CASEVAC guidelines. The rates of mis-categorisation between 'clinic hours' and 'AED hours', and that between the 'flying' and 'non-flying' hours, were compared. The patients' demographic data and their presenting symptoms were collected and analysed using logistic regression models to identify factors contributing to mis-categorisation. Results: The mis-categorisation rate was 60.1%. Among them, all were over-categorised. The over-categorisation rates between 'clinic hours' and 'AED hours', and between 'flying' and 'non-flying' hours, were not significantly different (p=0.07 and 0.09, respectively). Abnormal pulse rate was significantly associated with over-categorisation (p<0.01). Patients at extremes of age and psychiatric/ drunk patients were significantly less likely to be over-categorised (p<0.05 and p<0.01, respectively). There was 20% disagreement between the two assessors when applying the existing CASEVACs guidelines (kappa score 0.58 or 'moderate agreement'). Conclusions: Over-triage in CASEVAC categorisation is common irrespective of the time of day. Revision of the current CASEVAC guidelines is recommended. (Hong Kong j.emerg.med. 2013; 20:327-336) 目的：檢討用緊急撤離(CASEVAC)將病人從離島轉送到巿區醫院的分類並尋找那些在「無飛行時 間」中可能會導致誤分類的病人特徵。方法：我們檢討了在 2009 年期間的 459 個轉院病人的醫療報告。 由 2 個獨立的評估人員根據緊急撤離的指引去決定分類正確與否。誤分類率在「門診時間」和「急症 時間」及「飛行時間」和「無飛行時間」之間都作了比較。我們搜集了病人的人口統計學數據和他 們的主訴症狀並運用邏輯回歸法去分析以達致找出引至誤分類的因素。結果：誤分類率是 60.1% 。所有誤 分類個案都分類過高。過高分類率在「門診時間」和「急症時間」及「飛行時間」和「無飛行時 間」之間沒有明顯的區別(分別是 p=0.07 和 0.09)。不正常的脈搏率與分類過高明顯有關(p<0.01)。 病人兩極化年齡和精神病／醉酒的病人與過高分類明顯有較少的關係(分別是 p<0.05 和 p<0.01)。當 使用現時的緊急撤離指引時兩個評估人員之間持不同意見有 20% (kappa 評分 0.58 或中度同意)。結論： 在緊急撤離分類中，過高的分流是常見的並且不受時間影響。我們建議再審視現時的緊急撤離指引。

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

“…IFT to urban regional hospitals is often required for patients with major medical or surgical conditions not amenable to treatment provided by rural hospitals or clinics serving these regions. In Hong Kong, the Government Flying Service (GFS) is the sole provider of HEMS 11 , 12 . Unlike the Franco‐German physician‐led model and Anglo‐American paramedic‐staffed model, 13 these helicopters are routinely staffed with air crewman officer (ACMO) trained in first‐aid, basic life support and international trauma life support.…”

“…In Hong Kong, the Government Flying Service (GFS) is the sole provider of HEMS. 11,12 Unlike the Franco-German physician-led model and Anglo-American paramedic-staffed model, 13 these helicopters are routinely staffed with air crewman officer (ACMO) trained in first-aid, basic life support and international trauma life support. The service is complemented by trained doctors and nurses who are deployed as volunteers only during the daytime every Friday to Monday and on public holidays.…”