Offer to the Most Seriously Injured Children? A Review of the Database from 1994 to 1998 Hans Julius Heimdal, MD, Sentralsykehuset i Akershus, Avdeling for Akuttmedisin, P.O.Box 113, 1474 Nordbyhagen, Norway Purpose: The basic aim of the founders of the Norwegian Air Ambulance system was to bring an experienced anaesthesiologist and equipment usually available only in the hospital setting to a seriously injured or ill patient. In addition to the anaesthesiologist, the helicopter is staffed with an HEMS rescue paramedic and one pilot. This way, specialized evaluation and treatment could start at the scene of an accident. The purpose of this study was to review the quality of the care that the Air Ambulance at L~renskog offers the most injured children. Methods: This study is a retrospective review of the period 1994-1998, using data from the Norwegian Air Ambulance base at L~renskog. The children included were younger than 15 years old, had a major trauma that demanded a definitive airway, and were primarly treated and transported to a trauma hospital by the team from the helicopter service. To the extent possible, the proposed recommendation for uniform reporting of data following major trauma--the Utstein style has been employed. However, because of the retrospective nature of this study, all desired data were not available. In addition, we have compared the actual transport time with the helicopter to an estimated time for ground ambulance transport. Results: One-hundred-three children younger than 15 were transported to the regional trauma hospital in the study period. 30 of these met the inclusion criteria. One trauma was penetrating; the rest were blunt. More than 50% of the accidents were related to transportation; 80% of the children suffered a head injury. All patients had NACA-score (severity of injury or illness index) between 4 and 6, 93% had Glasgow Coma Scale (GCS) < 11, and 57% had Trauma Score < 13. The helicopter anaesthesiologist made the scores at the time of the air ambulance arrival at the accident scene. In 83% of the cases, a ground ambulance arrived before the air ambulance, in 17% of cases, this ambulance was staffed with a physician or a nurse in addition to the paramedics. The air ambulance had a mean time from dispatch to arrival at the patient of 26 minutes (6-49 minutes). The mean on-scene time was 24 minutes (5-48 minutes), the mean time from the scene of the accident to the trauma hospital was 28 minutes (15-60 minutes), and the mean time from dispatch to arrival trauma hospital was 78 minutes (56-128 minutes). The mean distance from the site of the accident to the trauma hospital was 86 km (20220 kin), and the estimated ground ambulance transport time from the accident scene to the trauma hospital was 62 minutes (20-120 minutes). Before arrival of the air ambulance, the ground ambulances gave oxygen therapy to 71% of the children, 26% were treated with jaw thrust, and 11% got a definitive airway with an orotracheal tube. All children who received a definitive airway before arrival of the helicopter service had asystole as primary heart rhythm. Anaesthetic nurses performed the intubation procedures, and all tubes were verified in the correct position.
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