Prehospital Trauma Care Provided by Helicopter Emergency Medical Service and Ground Emergency Medical Service: Does it Make a Difference?

Abstract

Background: The correlation between the quality of prehospital emergency care provided by ground ambulance and helicopter emergency medical services and outcome of major trauma patients was subject of many scientific papers. Yet there is no definitive proof for the superiority of HEMS. Methods: A retrospective cohort study on 276 multiple trauma patients admitted to the Department of Trauma Surgery of the Medical University Vienna (a level I trauma center in Austria) by ground ambulance (ground EMS, n = 172) or rescue helicopter (HEMS, n = 104), both physician staffed, has been performed. Prehospital and clinical documentation were analyzed. Demographics, time of rescue and of prehospital activities, medical condition of the patient on scene and upon admission (using MEES), type and severity of injuries (employing ISS), prehospital and early clinical treatment were analyzed in a comparative way, too. Results: Patients of helicopter (HEMS) and ground ambulance (ground EMS) were similar regarding age, sex and severity of injuries. Time from accident to admission was significantly shorter in HEMS patients. HEMS vs. ground EMS patients were considered to be in a more critical condition on scene, but judged significantly better at the time of admission. Early endotracheal intubation and chest tubing was performed more often in the HEMS group. HEMS patients received more fluid replacement and a more extensive pain management, especially significant regarding opioids. Time spent in the ER following the admission by HEMS was 2/3 in comparison to ground EMS admission. Intubation rate in the ER of HEMS patients was 50 % to ground EMS patients. Conclusions: Although on-scene advanced trauma life support by HEMS vs. ground EMS was more comprehensive, overall prehospital time was significantly shorter. The efficiency of HEMS vs. ground EMS is indicated by an improved emergency evaluation score (MEES) at hospital admission, lower likelihood of immediate airway management and chest tubing requirements, and therefore less time needed in the ED. The reasons for these findings are a more experienced HEMS crew and a therefore more invasive treatment in the field.

multiple injuries - prehospital treatment - HEMS versus ground EMS - outcome

References

• 1 Arfken C L, Shapiro M J, Bessey P Q, Littenberg B. Effectiveness of helicopter versus ground ambulance services for interfacility transport.  J Trauma. 1998;  45 785-790
• 2 Bartolacci R A, Munford B J, Lee A, McDougall P A. Air medical scene response to blunt trauma: effect on early survival.  Med J Aust. 1998;  169 612-616
• 3 Baker S P, O'Neill B, Haddon W, Long W B. The Injury Severity Score: a method for describing patients with multiple injuries and evaluating emergency care.  J Trauma. 1974;  14 187-196
• 4 Baxt W G, Moody P. The impact of advanced prehospital emergency care on the mortality of severely brain-injured patients.  J Trauma. 1987;  27 365-369
• 5 Beck A, Gebhard F, Kinzl L. Notärztliche Versorgung des Traumapatienten.  Notfall und Rettungsmedizin. 2002;  5 57-71
• 6 Bernhard M, Helm M, Aul A, Gries A. Präklinisches Management des Polytraumas.  Anästhesist. 2004;  53 887-904
• 7 Bickell W H, Bruttig S P, Millnamow G A, O'Benar J, Wade C E. The detrimental effects of intravenous crystalloid after aortotomy in swine.  Surgery. 1991;  110 529-536
• 8 Biewener A, Aschenbrenner U, Rammelt S, Grass R, Zwipp H. Impact of helicopter transport and hospital level on mortality of polytrauma patients.  J Trauma. 2004;  56 94-98
• 9 Brathwaite C E, Rosko M, McDowell R, Gallagher J, Proenca J, Spott M A. A critical analysis of on-scene helicopter transport on survival in a statewide trauma system.  J Trauma. 1998;  45 144-146
• 10 Cunningham P, Rutledge R, Baker C C, Clancy T V. A comparison of the association of helicopter and ground ambulance transport with the outcome of injury in trauma patients transported from the scene.  J Trauma. 1997;  43 940-946
• 11 Di Bartolomeo S, Sanson G, Nardi G, Scian F, Michelutto V, Lattuada L. Effects of 2 patterns of prehospital care on the outcome of patients with severe head injury.  Arch Surg. 2001;  136 1293-1300
• 12 Hennes H, Reinhardt T, Dick W. Beurteilung des Notfallpatienten mit dem Mainz Emergency Evaluation Score.  Notfallmedizin. 1992;  18 130-136
• 13 Hoitz J, Lampl L. Polytrauma: Präklinische Versorgung.  Notfall und Rettungsmedizin. 2004;  7 589-603
• 14 Koury S I, Moorer L, Stone C K, Stapczinsky J S, Thomas S H. Air vs. ground transport and outcome in trauma patients requiring urgent operative interventions.  Prehosp Emerg Care. 1998;  2 289-292
• 15 Lehmann U, Grotz M, Regel G, Rudolph S, Tscherne H. Hat die Initialversorgung des polytraumatisierten Patienten Einfluß auf die Ausbildung eines multiplen Organversagens?.  Unfallchirurg. 1995;  98 442-446
• 16 McNicholl B P. The golden hour and prehospital care.  Injury. 1994;  25 251-254
• 17 Nardi G, Massarutti D, Muzzi R, Kette F, De Monte A, Carnelos G A, Peressutti R, Berlot G, Giordano F, Gullo A. Impact of emergency medical helicopter service on mortality for trauma in north-east Italy. A regional prospective audit.  Eur J Emerg Med. 1994;  1 69-77
• 18 Regel G, Lobenhoffer P, Lehmann U, Pape H C, Pohlemann T. Ergebnisse in der Behandlung Polytraumatisierter - Eine vergleichende Analyse von 3 406 Fällen zwischen 1972 und 1991.  Unfallchirurg. 1993;  96 350-362
• 19 Schlechtriemen T, Lackner C K, Moecke H P, Arntz H R, Messelken M, Altemeyer K H. Medizinisches Qualitätsmanagement mit Hilfe ausgewählter Zieldiagnosen. Empfehlungen für eine einheitliche Dokumentation und Datenauswertung.  Notfall und Rettungsmedizin. 2003;  6 175-188
• 20 Spanjersberg W, Ringburg A, Bergs B. et al . Prehospital chest tube thoracostomy: effective treatment or additional trauma?.  J Trauma. 2005;  59 96-101
• 21 Thomas S H, Harrison T H, Buras W R, Ahmed W, Cheema F, Wedel S K. Helicopter transport and blunt trauma mortality: A multicenter trial.  J Trauma. 2002;  52 136-145