Abstract
BackgroundIt has been suggested that prehospital care teams that can provide advanced prehospital interventions may decrease the transit time through the ED to CT scan and subsequent surgery. This study is an exploratory analysis of data from the Head Injury Retrieval Trial (HIRT) examining the relationship between prehospital team type and time intervals during the prehospital and ED phases of management.MethodsThree prehospital care models were compared; road paramedics, and two physician staffed Helicopter Emergency Medical Services (HEMS) - HIRT HEMS and the Greater Sydney Area (GSA) HEMS. Data on prehospital and ED time intervals for patients who were randomised into the HIRT were extracted from the trial database. Additionally, data on interventions at the scene and in the ED, plus prehospital entrapment rate was also extracted. Subgroups of patients that were not trapped or who were intubated at the scene were also specifically examined.ResultsA total of 3125 incidents were randomised in the trial yielding 505 cases with significant injury that were treated by road paramedics, 302 patients treated by the HIRT HEMS and 45 patients treated by GSA HEMS. The total time from emergency call to CT scan was non-significantly faster in the HIRT HEMS group compared with road paramedics (medians of 1.9 hours vs. 2.1 hours P = 0.43) but the rate of prehospital intubation was 41% higher in the HIRT HEMS group (46.4% vs. 5.3% P < 0.001). Most time intervals for the GSA HEMS were significantly longer with a regression analysis indicating that GSA HEMS scene times were 13 (95% CI, 7–18) minutes longer than the HIRT HEMS independent of injury severity, entrapment or interventions performed on scene.ConclusionThis study suggests that well-rehearsed and efficient interventions carried out on-scene, by a highly trained physician and paramedic team can allow earlier critical care treatment of severely injured patients without increasing the time elapsed between injury and hospital-based intervention. There is also indication that role specialisation improves time intervals in physician staffed HEMS which should be confirmed with purpose designed trials.
Highlights
Traumatic brain injury (TBI) is one of the most significant causes of early trauma deaths and long-term morbidity, and is the leading cause of death in the first four decades of life in most developed countries
Thirty six of the 930 patients were excluded as they were treated by New South Wales (NSW) Ambulance (NSWA) physician teams prior to December 2007 and 5 patients were excluded as they were patients allocated to standard care but treated by the Head Injury Retrieval Trial (HIRT) medical team at the direction of the Rapid Launch Trauma Coordinator (RLTC) when no Greater Sydney Area (GSA) helicopter emergency medical service (HEMS) team was available
In 37 cases both a HIRT and GSA HEMS team were dispatched in parallel to the same case
Summary
Traumatic brain injury (TBI) is one of the most significant causes of early trauma deaths and long-term morbidity, and is the leading cause of death in the first four decades of life in most developed countries. Apart from injury prevention programs little can be done to reduce the primary injury, but prompt control of subsequent secondary injury can be achieved by controlling factors such as hypoxia, Garner et al Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine (2015) 23:28 mortality and morbidity in modern trauma systems. Proponents of such interventions suggest that time providing appropriate treatment in the prehospital setting streamlines the subsequent delivery of care for the patient once they reach the emergency department (ED). This study is an exploratory analysis of data from the Head Injury Retrieval Trial (HIRT) examining the relationship between prehospital team type and time intervals during the prehospital and ED phases of management
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