Citation

Franschman G, Verburg N, Brens-Heldens V, Andriessen TM, Van der Naalt J, Peerdeman SM, Valk JP, Hoogerwerf N, Greuters S, Schober P, Vos PE, Christiaans HM, Boer C. Injury 2012; 43(11): 1838-1842.

Affiliation

Department of Anesthesiology, VU University Medical Center, Amsterdam, The Netherlands.

Copyright

(Copyright © 2012, Elsevier Publishing)

DOI

10.1016/j.injury.2012.05.020

PMID

22695322

Abstract

INTRODUCTION: Prehospital care by physician-based helicopter emergency medical services (P-HEMS) may prolong total prehospital run time. This has raised an issue of debate about the benefits of these services in traumatic brain injury (TBI). We therefore investigated the effects of P-HEMS dispatch on prehospital run time and outcome in severe TBI. METHODS: Prehospital run times of 497 patients with severe TBI who were solely treated by a paramedic EMS (n=125) or an EMS/P-HEMS combination (n=372) were retrospectively analyzed. Other study parameters included the injury severity score (ISS), Glasgow Coma Scale (GCS), prehospital endotracheal intubation and predicted and observed outcome rates. RESULTS: Patients who received P-HEMS care were younger and had higher ISS values than solely EMS-treated patients (10%; P=0.04). The overall prehospital run time was 74±54min, with similar out-of-hospital times for EMS and P-HEMS treated patients. Prehospital endotracheal intubation was more frequently performed in the P-HEMS group (88%) than in the EMS group (35%; P<0.001). The prehospital run time for intubated patients was similar for P-HEMS (66 (51-80)min) and EMS-treated patients (59 (41-88min). Unexpectedly, mortality probability scores and observed outcome scores were less favourable for EMS-treated patients when compared to patients treated by P-HEMS. CONCLUSION: P-HEMS dispatch does not increase prehospital run times in severe TBI, while it assures prehospital intubation of TBI patients by a well-trained physician. Our data however suggest that a subgroup of the most severely injured patients received prehospital care by an EMS, while international guidelines recommend advanced life support by a physician-based EMS in these cases.

Language: en