Top

Published in:

Open Access 01-06-2013 | Research

Survival benefit of helicopter emergency medical services compared to ground emergency medical services in traumatized patients

Authors: Hagen Andruszkow, Rolf Lefering, Michael Frink, Philipp Mommsen, Christian Zeckey, Katharina Rahe, Christian Krettek, Frank Hildebrand

Published in: Critical Care | Issue 3/2013

Abstract

Introduction

Physician-staffed helicopter emergency medical services (HEMS) are a well-established component of prehospital trauma care in Germany. Reduced rescue times and increased catchment area represent presumable specific advantages of HEMS. In contrast, the availability of HEMS is connected to a high financial burden and depends on the weather, day time and controlled visual flight rules. To date, clear evidence regarding the beneficial effects of HEMS in terms of improved clinical outcome has remained elusive.

Methods

Traumatized patients (Injury Severity Score; ISS ≥9) primarily treated by HEMS or ground emergency medical services (GEMS) between 2007 and 2009 were analyzed using the TraumaRegister DGU^® of the German Society for Trauma Surgery. Only patients treated in German level I and II trauma centers with complete data referring to the transportation mode were included. Complications during hospital treatment included sepsis and organ failure according to the criteria of the American College of Chest Physicians/Society of Critical Care Medicine (ACCP/SCCM) consensus conference committee and the Sequential Organ Failure Assessment (SOFA) score.

Results

A total of 13,220 patients with traumatic injuries were included in the present study. Of these, 62.3% (n = 8,231) were transported by GEMS and 37.7% (n = 4,989) by HEMS. Patients treated by HEMS were more seriously injured compared to GEMS (ISS 26.0 vs. 23.7, P < 0.001) with more severe chest and abdominal injuries. The extent of medical treatment on-scene, which involved intubation, chest and treatment with vasopressors, was more extensive in HEMS (P < 0.001) resulting in prolonged on-scene time (39.5 vs. 28.9 minutes, P < 0.001). During their clinical course, HEMS patients more frequently developed multiple organ dysfunction syndrome (MODS) (HEMS: 33.4% vs. GEMS: 25.0%; P < 0.001) and sepsis (HEMS: 8.9% vs. GEMS: 6.6%, P < 0.001) resulting in an increased length of ICU treatment and in-hospital time (P < 0.001). Multivariate logistic regression analysis found that after adjustment by 11 other variables the odds ratio for mortality in HEMS was 0.75 (95% CI: 0.636 to 862).

Afterwards, a subgroup analysis was performed on patients transported to level I trauma centers during daytime with the intent of investigating a possible correlation between the level of the treating trauma center and posttraumatic outcome. According to this analysis, the Standardized Mortality Ratio, SMR, was significantly decreased following the Trauma Score and the Injury Severity Score (TRISS) method (HEMS: 0.647 vs. GEMS: 0.815; P = 0.002) as well as the Revised Injury Severity Classification (RISC) score (HEMS: 0.772 vs. GEMS: 0.864; P = 0.045) in the HEMS group.

Conclusions

Although HEMS patients were more seriously injured and had a significantly higher incidence of MODS and sepsis, these patients demonstrated a survival benefit compared to GEMS.

Available only for authorised users

Butler DP, Anwar I, Willett K: Is it the H or the EMS in HEMS that has an impact on trauma patient mortality? A systematic review of the evidence. Emerg Med J 2010, 27: 692-701. 10.1136/emj.2009.087486CrossRefPubMed

Plevin RE, Evans HL: Helicopter transport: help or hindrance? Curr Opin Crit Care 2011, 17: 596-600. 10.1097/MCC.0b013e32834c5655CrossRefPubMed

Taylor CB, Stevenson M, Jan S, Middleton PM, Fitzharris M, Myburgh JA: A systematic review of the costs and benefits of helicopter emergency medical services. Injury 2010, 41: 10-20. 10.1016/j.injury.2009.09.030CrossRefPubMed

Galvagno SM Jr, Haut ER, Zafar SN, Millin MG, Efron DT, Koenig GJ Jr, Baker SP, Bowman SM, Pronovost PJ, Haider AH: Association between helicopter vs ground emergency medical services and survival for adults with major trauma. JAMA 2012, 307: 1602-1610. 10.1001/jama.2012.467PubMedCentralCrossRefPubMed

Bulger EM, Guffey D, Guyette FX, MacDonald RD, Brasel K, Kerby JD, Minei JP, Warden C, Rizoli S, Morrison LJ, Nichol G: Impact of prehospital mode of transport after severe injury: a multicenter evaluation from the Resuscitation Outcomes Consortium. J Trauma Acute Care Surg 2012, 72: 567-573. discussion 573-565; quiz 803 10.1097/TA.0b013e31824baddfPubMedCentralCrossRefPubMed

Mommsen P, Bradt N, Zeckey C, Andruszkow H, Petri M, Frink M, Hildebrand F, Krettek C, Probst C: Comparison of helicopter and ground emergency medical service: a retrospective analysis of a German rescue helicopter base. Technol Health Care 2012, 20: 49-56.PubMed

Westhoff J, Hildebrand F, Grotz M, Richter M, Pape HC, Krettek C: Trauma care in Germany. Injury 2003, 34: 674-683. 10.1016/S0020-1383(03)00147-5CrossRefPubMed

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. 10.1097/01.TA.0000061883.92194.50CrossRefPubMed

Svenson JE, O'Connor JE, Lindsay MB: Is air transport faster? A comparison of air versus ground transport times for interfacility transfers in a regional referral system. Air Med J 2006, 25: 170-172. 10.1016/j.amj.2006.04.003CrossRefPubMed

10.

Baxt WG, Moody P: The impact of a rotorcraft aeromedical emergency care service on trauma mortality. JAMA 1983, 249: 3047-3051. 10.1001/jama.1983.03330460029027CrossRefPubMed

11.

Baxt WG, Moody P: The impact of a physician as part of the aeromedical prehospital team in patients with blunt trauma. JAMA 1987, 257: 3246-3250. 10.1001/jama.1987.03390230082029CrossRefPubMed

12.

Baxt WG, Moody P, Cleveland HC, Fischer RP, Kyes FN, Leicht MJ, Rouch F, Wiest P: Hospital-based rotorcraft aeromedical emergency care services and trauma mortality: a multicenter study. Ann Emerg Med 1985, 14: 859-864. 10.1016/S0196-0644(85)80634-XCrossRefPubMed

13.

Moront ML, Gotschall CS, Eichelberger MR: Helicopter transport of injured children: system effectiveness and triage criteria. J Pediatr Surg 1996, 31: 1183-1186. discussion 1187-1188 10.1016/S0022-3468(96)90114-1CrossRefPubMed

14.

Boyd CR, Corse KM, Campbell RC: Emergency interhospital transport of the major trauma patient: air versus ground. J Trauma 1989, 29: 789-793. discussion 793-794 10.1097/00005373-198906000-00015CrossRefPubMed

15.

Baker SP, O'Neill B, Haddon W Jr, Long WB: The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma 1974, 14: 187-196. 10.1097/00005373-197403000-00001CrossRefPubMed

16.

Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, Schein RM, Sibbald WJ: Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest 1992, 101: 1644-1655. 10.1378/chest.101.6.1644CrossRefPubMed

17.

Bone RC, Sprung CL, Sibbald WJ: Definitions for sepsis and organ failure. Crit Care Med 1992, 20: 724-726.CrossRefPubMed

18.

Vincent JL, de Mendonca A, Cantraine F, Moreno R, Takala J, Suter PM, Sprung CL, Colardyn F, Blecher S: Use of the SOFA score to assess the incidence of organ dysfunction/failure in intensive care units: results of a multicenter, prospective study. Working group on "sepsis-related problems" of the European Society of Intensive Care Medicine. Crit Care Med 1998, 26: 1793-1800. 10.1097/00003246-199811000-00016CrossRefPubMed

19.

Boyd CR, Tolson MA, Copes WS: Evaluating trauma care: the TRISS method. Trauma Score and the Injury Severity Score. J Trauma 1987, 27: 370-378. 10.1097/00005373-198704000-00005CrossRefPubMed

20.

Lefering R: Development and validation of the Revised Injury Severity Classification (RISC) score for severely injured patients. Eur J Trauma Emerg Surg 2009, 35: 437-447. 10.1007/s00068-009-9122-0CrossRef

21.

Schluter PJ: Trauma and Injury Severity Score (TRISS): is it time for variable re-categorisations and re-characterisations? Injury 2011, 42: 83-89. 10.1016/j.injury.2010.08.036CrossRefPubMed

22.

Bartolacci RA, Munford BJ, Lee A, McDougall PA: Air medical scene response to blunt trauma: effect on early survival. Med J Aust 1998, 169: 612-616.PubMed

23.

Frink M, Probst C, Hildebrand F, Richter M, Hausmanninger C, Wiese B, Krettek C, Pape HC: [The influence of transportation mode on mortality in polytraumatized patients. An analysis based on the German Trauma Registry]. Unfallchirurg 2007, 110: 334-340. 10.1007/s00113-006-1222-2CrossRefPubMed

24.

Nicholl JP, Brazier JE, Snooks HA: Effects of London helicopter emergency medical service on survival after trauma. BMJ 1995, 311: 217-222. 10.1136/bmj.311.6999.217PubMedCentralCrossRefPubMed

25.

Buntman AJ, Yeomans KA: The effect of air medical transport on survival after trauma in Johannesburg, South Africa. S Afr Med J 2002, 92: 807-811.PubMed

26.

Schwartz RJ, Jacobs LM, Juda RJ: A comparison of ground paramedics and aeromedical treatment of severe blunt trauma patients. Conn Med 1990, 54: 660-662.PubMed

27.

Schluter PJ: The Trauma and Injury Severity Score (TRISS) revised. Injury 2011, 42: 90-96. 10.1016/j.injury.2010.08.040CrossRefPubMed

28.

Brown JB, Stassen NA, Bankey PE, Sangosanya AT, Cheng JD, Gestring ML: Helicopters and the civilian trauma system: national utilization patterns demonstrate improved outcomes after traumatic injury. J Trauma 2010, 69: 1030-1034. discussion 1034-1036 10.1097/TA.0b013e3181f6f450CrossRefPubMed

29.

Ringburg AN, Spanjersberg WR, Frankema SP, Steyerberg EW, Patka P, Schipper IB: Helicopter emergency medical services (HEMS): impact on on-scene times. J Trauma 2007, 63: 258-262. 10.1097/01.ta.0000240449.23201.57CrossRefPubMed

30.

Sampalis JS, Lavoie A, Williams JI, Mulder DS, Kalina M: Impact of on-site care, prehospital time, and level of in-hospital care on survival in severely injured patients. J Trauma 1993, 34: 252-261. 10.1097/00005373-199302000-00014CrossRefPubMed

31.

van der Velden MW, Ringburg AN, Bergs EA, Steyerberg EW, Patka P, Schipper IB: Prehospital interventions: time wasted or time saved? An observational cohort study of management in initial trauma care. Emerg Med J 2008, 25: 444-449. 10.1136/emj.2007.052662CrossRefPubMed

32.

Nakstad AR, Strand T, Sandberg M: Landing sites and intubation may influence helicopter emergency medical services on-scene time. J Emerg Med 2011, 40: 651-657. 10.1016/j.jemermed.2010.05.067CrossRefPubMed

33.

Newgard CD, Schmicker RH, Hedges JR, Trickett JP, Davis DP, Bulger EM, Aufderheide TP, Minei JP, Hata JS, Gubler KD, Brown TB, Yelle JD, Bardarson B, Nichol G, Resuscitation Outcomes Consortium Investigators: Emergency medical services intervals and survival in trauma: assessment of the "golden hour" in a North American prospective cohort. Ann Emerg Med 2010, 55: 235-246.e4. 10.1016/j.annemergmed.2009.07.024PubMedCentralCrossRefPubMed

34.

Davis DP, Fakhry SM, Wang HE, Bulger EM, Domeier RM, Trask AL, Bochicchio GV, Hauda WE, Robinson L: Paramedic rapid sequence intubation for severe traumatic brain injury: perspectives from an expert panel. Prehosp Emerg Care 2007, 11: 1-8. 10.1080/10903120601021093CrossRefPubMed

35.

Miraflor E, Chuang K, Miranda MA, Dryden W, Yeung L, Strumwasser A, Victorino GP: Timing is everything: delayed intubation is associated with increased mortality in initially stable trauma patients. J Surg Res 2011, 170: 286-290. 10.1016/j.jss.2011.03.044CrossRefPubMed

36.

Trupka A, Waydhas C, Nast-Kolb D, Schweiberer L: Early intubation in severely injured patients. Eur J Emerg Med 1994, 1: 1-8. 10.1097/00063110-199403000-00002CrossRefPubMed

37.

Talving P, Teixeira PG, Barmparas G, DuBose J, Inaba K, Lam L, Demetriades D: Helicopter evacuation of trauma victims in Los Angeles: does it improve survival? World J Surg 2009, 33: 2469-2476. 10.1007/s00268-009-0185-1CrossRefPubMed

38.

Mulholland SA, Cameron PA, Gabbe BJ, Williamson OD, Young K, Smith KL, Bernard SA: Prehospital prediction of the severity of blunt anatomic injury. J Trauma 2008, 64: 754-760. 10.1097/01.ta.0000244384.85267.c5CrossRefPubMed

39.

Holmes JF, Wisner DH, McGahan JP, Mower WR, Kuppermann N: Clinical prediction rules for identifying adults at very low risk for intra-abdominal injuries after blunt trauma. Ann Emerg Med 2009, 54: 575-584. 10.1016/j.annemergmed.2009.04.007CrossRefPubMed

40.

Cooper DJ, McDermott FT, Cordner SM, Tremayne AB: Quality assessment of the management of road traffic fatalities at a level I trauma center compared with other hospitals in Victoria, Australia. Consultative Committee on Road Traffic Fatalities in Victoria. J Trauma 1998, 45: 772-779. 10.1097/00005373-199810000-00027CrossRefPubMed

41.

Sampalis JS, Denis R, Frechette P, Brown R, Fleiszer D, Mulder D: Direct transport to tertiary trauma centers versus transfer from lower level facilities: impact on mortality and morbidity among patients with major trauma. J Trauma 1997, 43: 288-295. discussion 295-296 10.1097/00005373-199708000-00014CrossRefPubMed

42.

Spruijt NE, Visser T, Leenen LP: A systematic review of randomized controlled trials exploring the effect of immunomodulative interventions on infection, organ failure, and mortality in trauma patients. Crit Care 2010, 14: R150. 10.1186/cc9218PubMedCentralCrossRefPubMed

43.

Nast-Kolb D, Aufmkolk M, Rucholtz S, Obertacke U, Waydhas C: Multiple organ failure still a major cause of morbidity but not mortality in blunt multiple trauma. J Trauma 2001, 51: 835-841. discussion 841-842 10.1097/00005373-200111000-00003CrossRefPubMed

44.

Brathwaite CE, Rosko M, McDowell R, Gallagher J, Proenca J, Spott MA: A critical analysis of on-scene helicopter transport on survival in a statewide trauma system. J Trauma 1998, 45: 140-144. discussion 144-146 10.1097/00005373-199807000-00029CrossRefPubMed

45.

Wafaisade A, Lefering R, Maegele M, Helm P, Braun M, Paffrath T, Bouillon B, TraumaRegister der Deutschen Gesellschaft für Unfallchirurgie: [Recombinant factor VIIa for the treatment of exsanguinating trauma patients: a matched-pair analysis from the Trauma Registry of the German Society for Trauma Surgery.]. Unfallchirurg 2013, 116: 524-530. 10.1007/s00113-011-2146-zCrossRefPubMed

46.

Kulla M, Helm M, Lefering R, Walcher F: Prehospital endotracheal intubation and chest tubing does not prolong the overall resuscitation time of severely injured patients: a retrospective, multicentre study of the Trauma Registry of the German Society of Trauma Surgery. Emerg Med J 2012, 29: 497-501. 10.1136/emj.2010.107391CrossRefPubMed

47.

Couch L, Yates K, Aickin R, Pena A: Investigating moderate to severe paediatric trauma in the Auckland region. Emerg Med Australas 2010, 22: 171-179. 10.1111/j.1742-6723.2010.01283.xCrossRefPubMed

Title: Survival benefit of helicopter emergency medical services compared to ground emergency medical services in traumatized patients
Authors: Hagen Andruszkow
Rolf Lefering
Michael Frink
Philipp Mommsen
Christian Zeckey
Katharina Rahe
Christian Krettek
Frank Hildebrand
Publication date: 01-06-2013
Publisher: BioMed Central
Published in: Critical Care / Issue 3/2013
Electronic ISSN: 1364-8535
DOI: https://doi.org/10.1186/cc12796

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Survival benefit of helicopter emergency medical services compared to ground emergency medical services in traumatized patients

Abstract

Introduction

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 3/2013

Towards zero rate in healthcare-associated infections: one size shall not fit all...

Cardiac ischemia in patients with septic shock randomized to vasopressin or norepinephrine

The obesity paradox in the ICU: real or not?

Algorithm-based management of bleeding in patients with extracorporeal membrane oxygenation

Meropenem and piperacillin/tazobactam prescribing in critically ill patients: does augmented renal clearance affect pharmacokinetic/pharmacodynamic target attainment when extended infusions are used?

Traumatic cardiac arrests - the action or the provider, what makes the difference?