Impact of a physician-staffed helicopter on a regional trauma system: a prospective, controlled, observational study

TY - JOUR

T1 - Impact of a physician-staffed helicopter on a regional trauma system

T2 - a prospective, controlled, observational study

AU - Hesselfeldt, R

AU - Steinmetz, J

AU - Jans, H

AU - Jacobsson, M-L B

AU - Andersen, D L

AU - Buggeskov, K

AU - Kowalski, Marcin Ryszard

AU - Praest, M

AU - Øllgaard, L

AU - Höiby, P

AU - Rasmussen, L S

N1 - © 2013 The Acta Anaesthesiologica Scandinavica Foundation.

PY - 2013/5

Y1 - 2013/5

N2 - Introduction: This study aims to compare the trauma system before and after implementing a physician-staffed helicopter emergency medical service (PS-HEMS). Our hypothesis was that PS-HEMS would reduce time from injury to definitive care for severely injured patients. Methods: This was a prospective, controlled, observational study, involving seven local hospitals and one level I trauma centre using a before and after design. All patients treated by a trauma team within a 5-month period (1 December 2009-30 April 2010) prior to and a 12-month period (1 May 2010-30 April 2011) after implementing a PS-HEMS were included.We compared time from dispatch of the first ground ambulance to arrival in the trauma centre for patients with Injury Severity Score (ISS) > 15. Secondary end points were the proportion of secondary transfers and 30-day mortality. Results: We included 1788 patients, of which 204 had an ISS > 15. The PS-HEMS transported 44 severely injured directly to the trauma centre resulting in a reduction of secondary transfers from 50% before to 34% after implementation (P = 0.04). Median delay for definitive care for severely injured patientswas 218 min before and 90 min after implementation (P < 0.01). The 30-day mortality was reduced from 29% (16/56) before to 14% (21/147) after PS-HEMS (P = 0.02). Logistic regression showed PS-HEMS had an odds ratio (OR) for survival of 6.9 compared with ground transport. Conclusions: Implementation of a PS-HEMS was associated with significant reduction in time to the trauma centre for severely injured patients.We also observed significantly reduced proportions of secondary transfers and 30-day mortality.

AB - Introduction: This study aims to compare the trauma system before and after implementing a physician-staffed helicopter emergency medical service (PS-HEMS). Our hypothesis was that PS-HEMS would reduce time from injury to definitive care for severely injured patients. Methods: This was a prospective, controlled, observational study, involving seven local hospitals and one level I trauma centre using a before and after design. All patients treated by a trauma team within a 5-month period (1 December 2009-30 April 2010) prior to and a 12-month period (1 May 2010-30 April 2011) after implementing a PS-HEMS were included.We compared time from dispatch of the first ground ambulance to arrival in the trauma centre for patients with Injury Severity Score (ISS) > 15. Secondary end points were the proportion of secondary transfers and 30-day mortality. Results: We included 1788 patients, of which 204 had an ISS > 15. The PS-HEMS transported 44 severely injured directly to the trauma centre resulting in a reduction of secondary transfers from 50% before to 34% after implementation (P = 0.04). Median delay for definitive care for severely injured patientswas 218 min before and 90 min after implementation (P < 0.01). The 30-day mortality was reduced from 29% (16/56) before to 14% (21/147) after PS-HEMS (P = 0.02). Logistic regression showed PS-HEMS had an odds ratio (OR) for survival of 6.9 compared with ground transport. Conclusions: Implementation of a PS-HEMS was associated with significant reduction in time to the trauma centre for severely injured patients.We also observed significantly reduced proportions of secondary transfers and 30-day mortality.

U2 - 10.1111/aas.12052

DO - 10.1111/aas.12052

M3 - Journal article

C2 - 23289798

SN - 0001-5172

VL - 57

SP - 660

EP - 668

JO - Acta Anaesthesiologica Scandinavica

JF - Acta Anaesthesiologica Scandinavica

IS - 5

ER -