Abstract
Study objective: Aero medical crews offer an advanced level of practice and rapid transport to definitive care; however, their efficacy remains unproven. Previous studies have used relatively small sample sizes or have been unable to adequately control the effect of other potentially influential variables. Here we explore the impact of aeromedical response in patients with moderate to severe traumatic brain injury. Methods: This was a cross-sectional study using our county trauma registry. All patients with trauma injury, who referred to our emergency department by helicopter or car, were included. The impact of aeromedical response was determined using logistic regression, adjusting for age, sex, mechanism, preadmissionGlasgowComa Scale score and Injury Severity Score. Finally, the aeromedical patients undergoing field intubation were compared with ground patients undergoing emergency department (ED) intubation. Results: A total of 243 patients meeting all inclusion and exclusion criteria and with complete data sets were identified. Overall mortality was 25% in the air- and ground-transported cohorts, but outcomes were not significantly better for the aeromedical patients when adjusted for age, sex, mechanism of injury, hypotension, Glasgow Coma Scale score, head Abbreviated Injury Score, and Injury Severity Score (adjusted odds ratio [OR] 1.90; 95% confidence interval [CI] 1.60 to 2.25; P: 0001). Good outcomes (discharge to home, jail, psychiatric facility, rehabilitation, or leaving against medical advice) were also higher in aeromedical patients (adjusted OR 1.36; 95% CI 1.18 to 1.58; P: 0001). Conclusion: Here we analyze a large database of patients with moderate to severe traumatic brain injury. Aeromedical response appears to yield no significantly improved outcomes after adjustment for multiple influential factors in patients with moderate to severe traumatic brain injury.
Highlights
Trauma is one of the common causes of death which has a considerable loss of productivity and subsequent social and economic damage [1,2,3]
We evaluated the services of a paramedical helicopter emergency medical service (HEMS) operating in the Emergency department
As a cross-sectional study, we screened all traumatic patients treated by the HEMS or ground ambulances who referred to Imam Khomeini Hospital between April 2011 and September of 2012
Summary
Trauma is one of the common causes of death which has a considerable loss of productivity and subsequent social and economic damage [1,2,3]. This factor is the fourth most frequent cause of death in the UK and the first reason of the loss of life in the young people in Iran. In spite of this high level importance of trauma care, many studies have reported that almost of the patients received less than good standard care practice with prehospital care and trauma networks [4].
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