Prehospital analysis of northern trauma outcome measures: the PHANTOM study

Abstract

ObjectiveTo compare the mortality and morbidity of traumatically injured patients who received additional prehospital care by a doctor and critical care paramedic enhanced care team (ECT), with those solely treated by a paramedic non-ECT.MethodsA retrospective analysis of Trauma Audit and Research Network (TARN) data and case note review of all severe trauma cases (Injury Severity Score ≥9) in North East England from 1 January 2014 to 1 December 2017 who were treated by the North East Ambulance Service, the Great North Air Ambulance Service or both. TARN methods were used to calculate the number of unexpected survivors or deaths in each group (W score (Ws)). The Glasgow Outcome Scores were contrasted to evaluate morbidity.ResultsThe ECT group treated 531 patients: there were 17 unexpected survivors and no unexpected deaths. The non-ECT group treated 1202 patients independently: there were no unexpected survivors and 31 unexpected deaths. The proportion of patients requiring critical care interventions differed between the two groups 49% versus 33% (CI for difference 12% to 20%). In the ECT group, the Ws was 3.22 (95% CI 0.79 to 5.64). In the non-ECT group, the Ws was −2.97 (95% CI −1.22 to −4.71). The difference between the Ws was 6.18 (95% CI 3.19 to 9.17). There was no evidence of worse morbidity in the ECT group.ConclusionThis is the first UK ECT service to demonstrate a risk-adjusted mortality benefit in trauma patients with no detriment in morbidity: our results demonstrate an additional 3.22 survivors per 100 severe trauma casualties when treated by an ECT. The authors encourage other ECT services to conduct similar research.

Pre-hospital emergency anaesthesia in the United Kingdom: an observational cohort study

“…These teams are capable of delivering pre-hospital airway management and other critical interventions, which has the potential to improve outcomes when compared with conventional emergency medical services. 7,8 HEMS ECTs travel to a scene by air or road, depending on the locality of the incident, the weather, or other operational factors. Advanced airway management has been highlighted as a research priority in physician-provided prehospital critical care.…”

What clinical crew competencies and qualifications are required for helicopter emergency medical services? A review of the literature

“…Three studies compared the competencies of HEMS doctors and HEMS paramedics, but did not report on the impact of competencies on patient outcomes [12,24,25]. Twelve studies compared patient outcomes between a doctor or paramedic/doctor staffed HEMS and a paramedic/nurse-staffed ground EMS [2,11,15,16,[20][21][22][23][26][27][28][29]. Four studies compared intervention and patient outcomes from paramedicstaffed HEMS with paramedic-staffed ground EMS [14,17,30,31].…”

“…A later Dutch study in a single centre confirmed these findings [21]. Finally, the PHANTOM study in the UK concluded that HEMS that were staffed by an enhanced care team (ECT) of doctors and critical care paramedics (CCPs) had a statistically significant benefit in adjusted survival rates for severe trauma patients when compared to patients solely treated by a ground-based paramedic [28].…”

The Effect of Physician-Led Enhanced Care Teams in Prehospital Trauma Resuscitation

“…Maddock et al discovered in Scotland that physician-led prehospital critical care teams (PHCCTs) resulted in reduced mortality in trauma patients, even when considering that patients who required PHCCTs generally had higher injury severity scores (ISS) [7]. Smith et al performed a study in the United Kingdom and were the first able to discern a risk-adjusted mortality benefit in patients treated by ECTs with no increase in morbidity [18]. On the other hand, Hepple et al reviewed the United Kingdom's Trauma Audit and Research Network (TARN) and could not demonstrate an improved adjusted survival rate for patients who were treated by a physician-led ECT [6].…”