9
views
0
recommends
+1 Recommend
0 collections
    0
    shares
      • Record: found
      • Abstract: not found
      • Article: not found

      Characteristics of Patients Transported by a Paramedic-staffed Helicopter Emergency Medical Service in Victoria, Australia

      , , , , ,
      Prehospital Emergency Care
      Informa UK Limited

      Read this article at

      ScienceOpenPublisher
      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Related collections

          Most cited references15

          • Record: found
          • Abstract: found
          • Article: not found

          Association between helicopter vs ground emergency medical services and survival for adults with major trauma.

          Helicopter emergency medical services and their possible effect on outcomes for traumatically injured patients remain a subject of debate. Because helicopter services are a limited and expensive resource, a methodologically rigorous investigation of its effectiveness compared with ground emergency medical services is warranted. To assess the association between the use of helicopter vs ground services and survival among adults with serious traumatic injuries. Retrospective cohort study involving 223,475 patients older than 15 years, having an injury severity score higher than 15, and sustaining blunt or penetrating trauma that required transport to US level I or II trauma centers and whose data were recorded in the 2007-2009 versions of the American College of Surgeons National Trauma Data Bank. Transport by helicopter or ground emergency services to level I or level II trauma centers. Survival to hospital discharge and discharge disposition. A total of 61,909 patients were transported by helicopter and 161,566 patients were transported by ground. Overall, 7813 patients (12.6%) transported by helicopter died compared with 17,775 patients (11%) transported by ground services. Before propensity score matching, patients transported by helicopter to level I and level II trauma centers had higher Injury Severity Scores. In the propensity score-matched multivariable regression model, for patients transported to level I trauma centers, helicopter transport was associated with an improved odds of survival compared with ground transport (odds ratio [OR], 1.16; 95% CI, 1.14-1.17; P < .001; absolute risk reduction [ARR], 1.5%). For patients transported to level II trauma centers, helicopter transport was associated with an improved odds of survival (OR, 1.15; 95% CI, 1.13-1.17; P < .001; ARR, 1.4%). A greater proportion (18.2%) of those transported to level I trauma centers by helicopter were discharged to rehabilitation compared with 12.7% transported by ground services (P < .001), and 9.3% transported by helicopter were discharged to intermediate facilities compared with 6.5% by ground services (P < .001). Fewer patients transported by helicopter left level II trauma centers against medical advice (0.5% vs 1.0%, P < .001). Among patients with major trauma admitted to level I or level II trauma centers, transport by helicopter compared with ground services was associated with improved survival to hospital discharge after controlling for multiple known confounders.
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            Prehospital rapid sequence intubation improves functional outcome for patients with severe traumatic brain injury: a randomized controlled trial.

            To determine whether paramedic rapid sequence intubation in patients with severe traumatic brain injury (TBI) improves neurologic outcomes at 6 months compared with intubation in the hospital. Severe TBI is associated with a high rate of mortality and long-term morbidity. Comatose patients with TBI routinely undergo endo-tracheal intubation to protect the airway, prevent hypoxia, and control ventilation. In many places, paramedics perform intubation prior to hospital arrival. However, it is unknown whether this approach improves outcomes. In a prospective, randomized, controlled trial, we assigned adults with severe TBI in an urban setting to either prehospital rapid sequence intubation by paramedics or transport to a hospital emergency department for intubation by physicians. The primary outcome measure was the median extended Glasgow Outcome Scale (GOSe) score at 6 months. Secondary end-points were favorable versus unfavorable outcome at 6 months, length of intensive care and hospital stay, and survival to hospital discharge. A total of 312 patients with severe TBI were randomly assigned to paramedic rapid sequence intubation or hospital intubation. The success rate for paramedic intubation was 97%. At 6 months, the median GOSe score was 5 (interquartile range, 1-6) in patients intubated by paramedics compared with 3 (interquartile range, 1-6) in the patients intubated at hospital (P = 0.28).The proportion of patients with favorable outcome (GOSe, 5-8) was 80 of 157 patients (51%) in the paramedic intubation group compared with 56 of 142 patients (39%) in the hospital intubation group (risk ratio, 1.28; 95% confidence interval, 1.00-1.64; P = 0.046). There were no differences in intensive care or hospital length of stay, or in survival to hospital discharge. In adults with severe TBI, prehospital rapid sequence intubation by paramedics increases the rate of favorable neurologic outcome at 6 months compared with intubation in the hospital.
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              A systematic review of the costs and benefits of helicopter emergency medical services.

              Helicopter emergency medical services (HEMS) are popular in first world health systems despite inconsistent evidence in the scientific literature to support their use. The aim of the current study was to perform a systematic review of economic evaluations of HEMS, in order to determine the economic cost of HEMS and the associated patient-centered benefits. A systematic review was performed of studies that provided a cost estimate of HEMS. The inclusion criteria consisted of English language articles that estimated both the costs and outcomes of a HEMS and fulfilled pre-specified criteria in relation to a cost analysis, cost-minimisation, cost-effectiveness or cost-benefit evaluation. Identified studies were synthesised according to the patient diagnosis (trauma, non-trauma or non-specific) and the type of HEMS transport under review (primary scene retrieval or secondary inter-facility transport). All costs were converted to US dollars and indexed for inflation. Fifteen studies met the inclusion criteria. Among all studies the annual cost of HEMS ranged from $115,777 to $5,571,578. Five studies showed HEMS to be a more expensive transport alternative without an associated benefit while eight studies provided cost-effectiveness ratios of $3292 and $2227 per life year saved for trauma, $3258 per life saved and $7138 and $12,022 per quality adjusted life year for non-trauma and $30,365 and $91,478 per beneficial mission for non-specific patient populations. One study also evaluated the cost of HEMS to societal benefit, producing a ratio of 1:6. The cost and effectiveness of HEMS varied considerably between studies. Despite generally being more expensive than ground transport, a number of studies found HEMS to be cost-effective. However, given the variation in the intervention design, context and study methods between studies it was not possible to assess the cost-effectiveness of HEMS in general. Given the variation inherent in the health systems in which HEMS operate, synthesis and extrapolation of study findings across differing health environments is difficult. To address economic and clinical evidence in relation to HEMS, future research that is tailored to account for local system factors is required.
                Bookmark

                Author and article information

                Journal
                Prehospital Emergency Care
                Prehospital Emergency Care
                Informa UK Limited
                1090-3127
                1545-0066
                February 06 2015
                February 17 2015
                : 19
                : 3
                : 416-424
                Article
                10.3109/10903127.2014.995846
                41fd666e-86dd-4a59-ba91-66350545ae74
                © 2015

                Comments

                Comment on this article