Abstract
BackgroundHelicopter Emergency Medical Services (HEMS) respond to serious trauma and medical emergencies. Geographical disparity and the regionalisation of trauma systems can complicate accurate HEMS dispatch. We sought to evaluate HEMS dispatch sensitivity in older trauma patients by analysing critical care interventions and conveyance in a well-established trauma system.MethodsAll trauma patients aged ≥65 years that were attended by the Air Ambulance Kent Surrey Sussex over a 6-year period from 1 July 2013 to 30 June 2019 were included. Patient characteristics, critical care interventions and hospital disposition were stratified by dispatch type (immediate, interrogate and crew request).Results1321 trauma patients aged ≥65 were included. Median age was 75 years [IQR 69–89]. HEMS dispatch was by immediate (32.0%), interrogation (43.5%) and at the request of ambulance clinicians (24.5%). Older age was associated with a longer dispatch interval and was significantly longer in the crew request category (37 min [34–39]) compared to immediate dispatch (6 min [5–6] (p = .001). Dispatch by crew request was common in patients with falls < 2 m, whereas pedestrian road traffic collisions and falls > 2 m more often resulted in immediate dispatch (p = .001). Immediate dispatch to isolated head injured patients often resulted in pre-hospital emergency anaesthesia (PHEA) (39%). However, over a third of head injured patients attended after dispatch by crew request received PHEA (36%) and a large proportion were triaged to major trauma centres (69%).ConclusionsMany patients who do not fulfil the criteria for immediate HEMS dispatch need advanced clinical interventions and subsequent tertiary level care at a major trauma centre. Further studies should evaluate if HEMS activation criteria, nuanced by age-dependant triggers for mechanism and physiological parameters, optimise dispatch sensitivity and HEMS utilisation.
Highlights
Advances in healthcare have enabled greater independence and activity in older people [1, 2]
The Helicopter Emergency Medical Services (HEMS) team brings advanced clinical procedures to complement the scope of practice provided by a land based Critical Care Paramedic (CCP), to include: prehospital emergency anaesthesia (PHEA), advanced analgesia and sedation, blood product transfusion and surgical intervention
Anticoagulant reversal was administered in a similar proportion of patients across each dispatch type (p = .152) (Table 3). In this retrospective cohort analysis on HEMS dispatch to older trauma, we demonstrate that many older trauma patients who do not fulfil the initial criteria for immediate dispatch, need advanced interventions and subsequent tertiary level care at a major trauma centre
Summary
Advances in healthcare have enabled greater independence and activity in older people [1, 2] This has led to a greater prevalence of older trauma, with 50% of severely injured patients over the age of 65-years recorded on the Trauma Audit and Research Network (TARN) [2, 3]. Helicopter Emergency Medical Services (HEMS) provide enhanced pre-hospital medical care to major trauma victims. Accurate HEMS dispatch is critical to the appropriate activation of an enhanced care team to those patients whom may benefit most from advanced critical care interventions [5,6,7]. Various dispatch algorithms enhance sensitivity by coupling mechanism with anatomical and physiological criteria [7] These have been shown to decrease HEMS activations to 55% of trauma patients, whilst at the same time accurately directing the enhanced care team to higher acuity patients [8]. We sought to evaluate HEMS dispatch sensitivity in older trauma patients by analysing critical care interventions and conveyance in a well-established trauma system
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