Jones J B, Leicht M, Dula D J
Methodist Hospital of Indiana-Clarian Health System, Indianapolis, USA.
Air Med J. 1998 Jan-Mar;17(1):7-11; discussion 11-2. doi: 10.1016/s1067-991x(98)90081-5.
The objective of this retrospective descriptive study was to evaluate the use of air medical services in response to medical scene calls for transport to tertiary care in the rural setting.
This study is a retrospective descriptive review of all medical scene calls during a 10-year study period. The cases were analyzed for demographics, transport time, medical indication, procedures, role of ground EMS services, effects on community hospitals, and patient outcomes. A case-by-case review by emergency medicine (EM) physicians was conducted to determine necessity of air medical transport.
A total of 8106 medical flights were conducted during the study period. Of these, 103 were scene calls for which 85 charts were available for review. The breakdown of medical scene calls is cardiac (29%), poisoning (17%), co poisoning (11%), neurologic (11%), and other (32%). Ground EMS was involved in 80% of the cases; ground advanced life support (ALS) was present in 58%. In 86% of the flights reviewed, an EM resident was aboard the helicopter. Of the 85 patients whose charts were available, 41 required admission to the ICU, five required hyperbaric oxygen (HBO) treatment, and 14 died before admission.
Evacuation of the rural patient with a medical emergency accounts for an extremely small percentage of an air medical service's use. ALS services, including emergency procedures at the scene and rapid transport to a tertiary care, were provided. Seventy-one percent of the flights reviewed required transport to a tertiary care facility, indicating that air medical transport was appropriate. Physician guidelines to ensure effective and cost-efficient use of these services should be developed. Responding for victims in cardiopulmonary arrest appears to provide little benefit with respect to outcome.
这项回顾性描述性研究的目的是评估在农村地区为响应医疗现场呼叫以转运至三级医疗机构而使用空中医疗服务的情况。
本研究是对10年研究期间所有医疗现场呼叫进行的回顾性描述性综述。对病例进行了人口统计学、转运时间、医疗指征、操作程序、地面急救医疗服务的作用、对社区医院的影响以及患者结局的分析。由急诊医学（EM）医生逐案审查以确定空中医疗转运的必要性。
研究期间共进行了8106次医疗飞行。其中，103次是现场呼叫，有85份病历可供审查。医疗现场呼叫的分类为心脏疾病（29%）、中毒（17%）、合并中毒（11%）、神经系统疾病（11%）和其他（32%）。80%的病例涉及地面急救医疗服务；58%有地面高级生命支持（ALS）。在审查的飞行中，86%的直升机上有急诊医学住院医师。在85例有病历的患者中，41例需要入住重症监护病房（ICU），5例需要高压氧（HBO）治疗，14例在入院前死亡。
农村医疗紧急情况患者的撤离在空中医疗服务使用中所占比例极小。提供了包括现场急救程序和快速转运至三级医疗机构的ALS服务。审查的飞行中有71%需要转运至三级医疗机构，表明空中医疗转运是合适的。应制定医生指南以确保有效且经济高效地使用这些服务。对心肺骤停受害者进行响应似乎对结局益处不大。
