Helicopter primary retrieval: Tasking who should do it?

Abstract

Cairns Base Hospital utilizes a helicopter retrieval system, which until 2001 had been tasked and staffed by emergency physicians. Since 2001, the ambulance service has assumed the role of both tasking and staffing the helicopter with intensive care paramedics. The present study examines whether the change has resulted in different activation patterns and patient outcomes. A retrospective chart review over 4 consecutive years, comparing the two groups, was carried out examining 30 day mortality, length of in-hospital stay, transfer rates, the Revised Trauma Score where appropriate and rates of discharge directly from the ED. A total of 374 patients were retrieved (211 patients in the emergency physician group from 1 April 1999 to 31 March 2001 and 163 in the ambulance group from 1 April 2001 to 31 March 2003) over the 4 year period. The demographics of the two groups were similar. Fifty-four patients in the ambulance group (33.1%) were discharged from the ED without admission while 31 (14.7%) were discharged from the physician group. This was statistically significant (P = 0.0001). There were no other significant differences between the two groups. The subgroup of patients admitted also did not show any significant difference in outcomes. The similarities in outcomes for admitted patients support the view that both groups have similar tasking criteria for high-acuity patients and suggest that paramedics are as efficacious as physicians in delivering prehospital care in this group of patients. However, for lower-acuity patients, there is a statistically significant higher rate of clinically unnecessary taskings by the ambulance group. Given the recent fatal aeromedical accidents in Queensland (Thursday Island 1998, Rockhampton 1999 and Mackay 2003), it would seem prudent to reduce clinically unnecessary retrievals through clinical coordination with appropriately qualified emergency physicians.