Abstract
BackgroundSevere paediatric trauma patients benefit from direct transport to dedicated Paediatric Trauma Centres (PTC). Parallel case identification systems utilising paramedics from a centralised dispatch centre versus the crew of a physician staffed Helicopter Emergency Medical Service (HEMS) allowed comparison of the two systems for case identification rates and subsequent timeliness of direct transfer to a PTC.MethodsPaediatric trauma patients over a two year period from the Sydney region with an Injury Severity Score (ISS) > 15 were retrospectively identified from a state wide trauma registry. Overall paediatric trauma system performance was assessed by comparisons of the availability of the physician staffed HEMS for patient characteristics, transport mode (direct versus indirect) and the times required for the patient to arrive at the paediatric trauma centre. The proportion of patients transported directly to a PTC was compared between the times that the HEMS service was available versus the time that it was unavailable to determine if the HEMS system altered the rate of direct transport to a PTC. Analysis of variance was used to compare the identifying systems for various patient characteristics when the HEMS was available.ResultsNinety nine cases met the inclusion criteria, 44 when the HEMS system was operational. Patients identified for physician response by the HEMS system were significantly different to those that were not identified with higher median ISS (25 vs 18, p = 0.011), and shorter times to PTC (67 vs 261mins, p = 0.015) and length of intensive care unit stays (2 vs 0 days, p = 0.045). Of the 44 cases, 21 were not identified, 3 were identified by the paramedic system and 20 were identified by the HEMS system, (P < 0.001). Direct transport to a PTC was more likely to occur when the HEMS dispatch system was available (RR 1.81, 95% CI 1.20-2.73). The median time (minutes) to arrival at the PTC was shorter when HEMS available (HEMS available 92, IQR 50-261 versus HEMS unavailable 296, IQR 84-583, P < 0.01).ConclusionsPhysician staffed HEMS crew dispatch is significantly more likely to identify cases of severe paediatric trauma and is associated with a greater proportion of transports directly to a PTC and with faster times to arrival.
Highlights
Severe paediatric trauma patients benefit from direct transport to dedicated Paediatric Trauma Centres (PTC)
Cases were abstracted from the New South Wales (NSW) Institute of Trauma and Injury Management (ITIM) State trauma registry, Australia, if they met the following inclusion criteria: o Age < 16 years. o Incidents within the Sydney coordination area of the Ambulance Service of NSW (ASNSW). o Injury Severity Score (ISS) > 15. o Incident notification occurred via the 000 public access emergency call system. o Incidents occurred between 24th May 2008 and 23rd
Overall paediatric trauma system performance was assessed by comparisons of the availability of Head Injury Retrieval Trial (HIRT) for patient characteristics, transport mode and the times required for the patient to arrive at the paediatric trauma centre using Chi square test, t-tests or the Mann Whitney U test as appropriate
Summary
Severe paediatric trauma patients benefit from direct transport to dedicated Paediatric Trauma Centres (PTC). It is NSW state trauma policy that all severely injured children be managed in PTCs. Patients are either directly transported to a PTC by the EMS system or are transferred after initial assessment in an adult trauma centre (ATC). Prospective research from a single Sydney centre showed that the majority of severely injured paediatric trauma patients from within the Sydney region were initially taken to an ATC, requiring later secondary transfer to a PTC with an average delay of more than six hours from time of injury to arrival at the PTC [6]. The Head Injury Retrieval Trial (HIRT) [8] is a randomised controlled trial of physician prehospital care delivered via a helicopter emergency medical system (HEMS) compared with paramedic care for severe blunt head injury within the urban area of Sydney, Australia. Responses were mounted only to children likely to have a severe head injury but from May 2008, the dispatch criteria were expanded to include all types of severe paediatric injury and drownings
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