Tortella B J, Sambol J, Lavery R F, Cudihy K, Nadzam G
New Jersey Trauma Center, University Hospital, Newark, USA.
Air Med J. 1996 Jan-Mar;15(1):24-8. doi: 10.1016/s1067-991x(96)90015-2.
There is a paucity of data comparing injured pediatric patients transported by helicopter emergency medical services (HEMS) with patients transported by ground ambulance. The purpose of this study was to compare HEMS pediatric trauma patients to: 1) pediatric patients transported by ground to an urban level-1 trauma center (TC), and; 2) a similar cohort of adult patients. The managed-care consequences of these comparisons are highlighted.
All trauma patients flown directly from the scene by HEMS from January 1, 1990, to April 30, 1993, were compared to a cohort of trauma patients arriving by ground advanced life support (ALS). All patients were transported to the same level-1 TC. The data collected included the mechanism of injury and the prehospital procedures performed, the injury severity score (ISS), and outcome.
There was no difference in the ISS between the HEMS (n = 216) and ground ALS (n = 355) pediatric patients (16.8 vs 17.1; p = 0.55). Adult HEMS patients (n = 202) had significantly higher ISS than did injured adults (n = 1652) transported by ground (18.0 vs 13.6; p < 0.0001). Overall, trauma patients transported by air directly from the scene have a higher ISS than patients transported by ground (17.5 vs 13.6; p < 0.001).
Pediatric patients transported by HEMS were as severely injured as those transported by ground, in contrast to adult patients. We conjecture that since trauma triage schemes classically focus on adults, ground personnel are more selective about which patients are flown to a TC, and less selective for pediatric patients. Trauma centers and HEMS programs should develop pediatric trauma triage protocols that do not overemphasize physiologic parameters.
将直升机紧急医疗服务（HEMS）转运的受伤儿科患者与地面救护车转运的患者进行比较的数据很少。本研究的目的是将HEMS儿科创伤患者与以下两类患者进行比较：1）通过地面转运至城市一级创伤中心（TC）的儿科患者；2）类似的成年患者队列。突出了这些比较在管理式医疗方面的影响。
将1990年1月1日至1993年4月30日期间由HEMS直接从现场空运的所有创伤患者与一组通过地面高级生命支持（ALS）抵达的创伤患者进行比较。所有患者均被转运至同一级别的一级TC。收集的数据包括损伤机制和院前实施的程序、损伤严重程度评分（ISS）以及结局。
HEMS（n = 216）和地面ALS（n = 355）儿科患者的ISS没有差异（16.8对17.1；p = 0.55）。成年HEMS患者（n = 202）的ISS显著高于通过地面转运的受伤成年人（n = 1652）（18.0对13.6；p < 0.0001）。总体而言，直接从现场通过空运转运的创伤患者的ISS高于通过地面转运的患者（17.5对13.6；p < 0.001）。
与成年患者不同，由HEMS转运的儿科患者与由地面转运的患者受伤程度相同。我们推测，由于创伤分诊方案传统上侧重于成年人，地面人员对于哪些患者被空运至TC更具选择性，而对儿科患者的选择性较小。创伤中心和HEMS项目应制定不过度强调生理参数的儿科创伤分诊方案。
