Patients transported by helicopter fare better
Patients transported by helicopter fare better
Staffing may have more impact than speed
A recent study in the Annals of Emergency Medicine finds that patients with traumatic brain injuries who are transported by medical helicopters have higher chances of survival and better recoveries than ground-transported patients.1
The study, "The Impact of Aeromedical Response to Patients with Moderate-to-Severe Traumatic Brain Injury," drew on San Diego County Trauma Registry data from January 1987 to December 2003, with a review of 10,314 cases of patients with moderate-to-severe head injuries, including 3,017 patients transported by aeromedical crews.
"Until now, there has been very little evidence to support whether frequently used air transport provides any more benefit to injured patients than ground transport," says lead author Daniel P. Davis, MD, an emergency medicine physician at the University of California San Diego Department of Emergency Medicine and Mercy Air Medical Services in San Diego.
However, he concedes, it may not have much to do with the speed of air transport. "Even I would agree in that most cases they don’t [save time]," Davis tells ED Management. In most cases today, paramedics go in first and make an assessment, he says. "If it’s a medical trauma, they will then call for a helicopter," Davis explains. "After that, it’s another 10 minutes or more until they get to the scene."
A unique model
What is behind the impressive San Diego statistics? Davis says it’s the system’s philosophical approach — combined with its staffing model.
They view the helicopters as an extension of the ED, he explains. "Things that happen in the ED are similar to what our medical crew is doing," Davis says.
"In San Diego, we use a flight nurse who has a minimum of five years’ experience in the ED or ICU [intensive care unit], plus additional training by me in airway management."
The helicopter also has a paramedic or sometimes an emergency medicine medic. In other areas of the country, they may just have emergency medical technicians, he says.
With this model, patients receive care paramedics simply cannot provide, Davis emphasizes.
"This includes aggressive airway management, vascular access to make sure there is some way to deliver [intravenous] fluids, giving meds, and decompressing a tension pneumothorax, which can otherwise lead to cardiovascular collapse," he says. "Paramedics either can’t do them or don’t do them as well."
However, helicopters should not be dispatched automatically to the site of a major trauma victim, he contends. "It’s usually a joint decision with [the paramedics on the scene and] the ED manager, and most counties have a protocol," says Davis. "In Riverside County [CA], for example, unless you are more than 30 minutes from the hospital by ground, you cannot call for a helicopter."
However, he says, there are two other reasons to consider calling for a helicopter. One is the anticipated need for an advanced procedure on the scene, he says. The second reason involves the capabilities of the hospital. "The helicopter can quickly bypass facilities that don’t have the ability to take care of critically injured patients and get to a facility that has advanced care," Davis notes.
While the staffing model in San Diego clearly works well, it may not be the best model for your area, says Robert Suter, DO, MHA, FACEP, president of the American College of Emergency Physicians in Irving, TX. Suter has years of experience in air medical programs, including a MAST (Military Assistance to Safety & Traffic) Army program before the first Gulf conflict. A MAST program provides civilian assistance via U.S. Army medical evaluation services.
"I think the staffing model that is best for any one system is what works for them and gives them the best overall outcomes," he offers. "This can be very controversial, because people hold strong opinions, and there is no definitive study that proves one staffing model is better than any other."
Among the variables, of course, is budget. "If I had an unlimited budget, I’d fly two board-certified emergency physicians, which would ideal," says Suter. "But you’d still have to give them extra training, because there would be things they are not used to doing."
In fact, says Suter, everyone on the team comes with weaknesses. "Nurses know that ICU or ED physicians do not routinely to do things like hanging drips, while nurses have less procedural knowledge of intubation," he says. "The bottom line is, use whatever works best for your program."
Davis agrees there is a wide variety of staffing models in use. "About half of the programs in the country are hospital-based, and as part of the team you, the ED manager, should determine what the model would be," he adds. In Europe, for example, a physician is part of the helicopter team, and an anesthesiologist performs airway management, Davis says. "They claim their outcomes are better, and I believe them," he says.
Davis also predicts there will be a shift in staffing in the United States. "More and more you will see on-the-fly triaging’ in conjunction with hospital programs," he notes.
Reference
- Davis DP, Peay J, Serrano JA, et al. The impact of aeromedical response to patients with moderate-to-severe traumatic brain injury. Ann Emerg Med 2005; 46:115-122.
Sources
For information on medical helicopter transfers, contact:
- Daniel P. Davis, MD, University of California San Diego Department of Emergency Medicine, Mercy Air Medical Services. Phone: (888) 201-0750.
- Robert E. Suter, DO, MHA, FACEP, President, American College of Emergency Physicians, 1125 Executive Circle, Irving, TX 75038-2522. Phone: (800) 798-1822. E-mail: [email protected].
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