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

R Hesselfeldt, J Steinmetz, H Jans, M-L B Jacobsson, D L Andersen, K Buggeskov, M Kowalski, M Praest, L Øllgaard, P Höiby, L S Rasmussen, R Hesselfeldt, J Steinmetz, H Jans, M-L B Jacobsson, D L Andersen, K Buggeskov, M Kowalski, M Praest, L Øllgaard, P Höiby, L S Rasmussen

Abstract

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 patients was 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.

© 2013 The Acta Anaesthesiologica Scandinavica Foundation.

Figures

Fig. 1
Fig. 1
Flow chart of included trauma patients and distribution of severely injured [Injury Severity Score (ISS) > 15] between ground and physician-staffed helicopter emergency medical service (PS-HEMS) transport.
Fig. 2
Fig. 2
Triage of severely injured patients (Injury Severity Score (ISS) > 15) to hospital facility before and after implementation of a physician-staffed helicopter emergency medical service (PS-HEMS). *P < 0.05.

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