Short-term outcome and differences between rural and urban trauma patients treated by mobile intensive care units in Northern Finland: a retrospective analysis

Abstract

BackgroundEmergency medical services are an important part of trauma care, but data comparing urban and rural areas is needed. We compared 30-day mortality and length of intensive care unit (ICU) stay for trauma patients injured in rural and urban municipalities and collected basic data on trauma care in Northern Finland.MethodsWe examined data from all trauma patients treated by the Finnish Helicopter Emergency Medical Services in 2012 and 2013. Only patients surviving to hospital were included in the analysis but all pre-hospital deaths were recorded. All data was retrieved from the national Helicopter Emergency Medical Services database, medical records, and the Finnish Causes of Death Registry. Patients were defined as urban or rural depending on the type of municipality where the injury occurred.ResultsA total of 472 patients were included. Age and Injury Severity Score did not differ between rural and urban patients. The pre-hospital time intervals and distances to trauma centers were longer for rural patients and a larger proportion of urban patients had intentional injuries (23.5 % vs. 9.3 %, P <0.001). The 30-day mortality for severely injured patients (Injury Severity Score >15) was 23.9 % in urban and 13.3 % in rural municipalities. In the multivariate regression analysis the odds ratio (OR) for 30-day mortality was 2.8 (95 % confidence interval 1.0 to 7.9, P = 0.05) in urban municipalities. There was no difference in the length of ICU stay or scores. Twenty patients died on scene or during transportation and 56 missions were aborted because of pre-hospital death.ConclusionsThe severely injured urban trauma patients had a trend toward higher 30-day mortality compared with patients injured in rural areas but the length of ICU stay was similar. However, more pre-hospital deaths occurred in rural municipalities. The time before mobile ICU arrival appears to be critical for trauma patients’ survival, especially in rural areas.

Missions of the Helicopter Emergency Medical Service in rural and urban areas in Poland – A comparative retrospective analysis

“…This is the first retrospective analysis covering 35,213 missions carried out by crews of HEMS from the whole country, in which over two-thirds of all completed missions took place in rural areas. The study conducted by Raatiniemi et al concerning HEMS missions to patients with body injuries in Finland also showed that these missions were carried out more often in rural areas [18]. Similar results were obtained by Strehlow at al.…”

“…Similarly, the distance to the scene and the distance to hospital were longer in the case of missions in rural areas. The results of the authors' own research has been confirmed by the study carried out by Raatiniemi et al, who analysed HEMS missions in Finland [18]. This confirms the legitimacy for dispatching HEMS crews to rural areas and places difficult to access for ground teams, because by using the air route it is possible to shorten the time of reaching the patient and the time of transporting the patient to hospital.…”

Human and equipment resources for difficult airway management, airway education programs, and capnometry use in Japanese emergency departments: a nationwide cross-sectional study

“…The exposures in this study were ED characteristics, including academic, high-volume, tertiary, and urban. Several of these factors were chosen as exposures because previous studies have shown that such hospital characteristics can affect patient outcomes [ 54 – 57 ]. Based on these earlier observations, we hypothesized that such ED types also may be associated with DAM preparedness, airway education, and standardized post-intubation care.…”

Prehospital and hospital delays for stroke patients treated with thrombolysis: A retrospective study from mixed rural–urban area in Northern Finland

“…Five physician-staffed helicopters and one with a paramedic are provided by the nation-wide Finnish helicopter emergency medical services (FinnHEMS), and the doctors by hospital districts [20]. During the study period, the physician-staffed helicopter that was located in the vicinity of OUH was dispatched only at a specific request of the ground ambulance crew in cases of stroke.…”