Gries A, Sikinger M, Hainer C, Ganion N, Petersen G, Bernhard M, Schweigkofler U, Stahl P, Braun J
Interdisziplinäre Notfallaufnahme, Klinikum Fulda gAG, Pacelliallee 4, 36043 Fulda, Deutschland.
Anaesthesist. 2008 Jun;57(6):562-70. doi: 10.1007/s00101-008-1373-3.
Time plays a crucial role in treating multiple traumatized patients and delays in management worsen the prognosis. Furthermore, current studies show that trauma patients profit from primary delivery to a trauma center. Therefore, the goal of physician-staffed ground and air rescue services in Germany is to treat these patients as quickly as possible and deliver them to a suitable trauma center. The aim of the present study was to investigate prehospital treatment times for the air rescue team in terms of disposition and efficiency when a ground rescue team was already present at the scene.
In a nationwide, multicenter analysis emergency missions carried out for traumatological emergencies in 2006 by 28 air rescue centers (ARC) of the TeamDRF and 6 ARC of the federal police were evaluated using the medical database MEDAT of the German Air Rescue Service. A distinction was made between combined missions with (MEDAT 1 group) and without (MEDAT 2 group) physician-staffed ground emergency medical services already being present at the emergency site and in particular the rescue helicopter treatment times for both groups were investigated. Furthermore, combined missions (MAN 1 group) and solo missions (MAN 2 group) for traumatological emergencies in the period 01.05.2006 to 31.01.2007 were investigated in a complementary prospective regional study at the ARC Heidelberg/Mannheim "Christoph 53". In both groups the total treatment times for all physician-staffed emergency systems involved in treatment at the scene were investigated.
Nationwide, 26,010 primary missions could be evaluated and of these, 11,464 missions were traumatological emergencies (44.1%) with 2,229 (19.4%) carried out by the MEDAT 1 group and 9,235 (80.6%) by the MEDAT 2 group. For both groups the helicopter treatment times depended on the severity of the injuries (NACA classification) and were between 17+/-12 min (NACA I) and 34+/-19 min (NACA VII) in MEDAT group 1 versus 21+/-10 and 36+/-19 min in MEDAT group 2 (p<0.05, p<0.001), respectively. In the MEDAT 1 group, the average treatment times were between 2.8 min (NACA VII) and 8.1 min (NACA VI) shorter compared with the MEDAT 2 group. Moreover, when taking the severity of the injury into consideration, a regular and significantly higher treatment effort (e.g. intubation, repositioning and chest tube insertion) and a greater proportion of patients who were transported to the clinic via rescue helicopter were observed for the MEDAT 1 group than for the MEDAT 2 group. In the regional study 670 primary missions were evaluated including 382 traumatological emergencies (57%). From these, 90 multiple trauma patients (NACA V) were not resuscitated or died at the scene, 58 from the MAN 1 group and 32 from the MAN 2 group, and were investigated more closely. The helicopter treatment times were comparable to those observed in the nationwide study and were found to be 26+/-12 min and 35+/-20 min (p<0.05), respectively. In the MAN 1 group the treatment times for the ground rescue services up to the time when the helicopter arrived was 22+/-11 min on average; the total treatment time was 48+/-15 min and 12+/-8 min longer than the time for the MAN 2 group, which was statistically significant. In the MAN 1 group the helicopter was alerted on average 17+/-15 min after the physician-staffed ground rescue services arrived at the emergency site. Treatment by the rescue helicopter teams was significantly more extensive in the MAN 1 group.
The treatment times for the helicopter were several minutes shorter when a physician-staffed ground rescue team had already arrived at the emergency site. However, it must be assumed that the total prehospital time is significantly longer for such missions. These results directly affect the disposition at the emergency dispatch center and indicate that when air rescue is required to transport a patient to hospital, the helicopter should be alerted at an early stage. In such settings, it is likely that initiating the operation in this way would improve the prognosis of severely injured patients and save costs.
时间在治疗多发伤患者过程中起着至关重要的作用，救治延迟会使预后恶化。此外，目前的研究表明创伤患者从直接被送往创伤中心中获益。因此，德国配备医生的地面和空中救援服务的目标是尽快治疗这些患者并将他们送到合适的创伤中心。本研究的目的是在地面救援团队已在现场的情况下，从调度和效率方面调查空中救援团队的院前治疗时间。
在一项全国性的多中心分析中，使用德国空中救援服务的医疗数据库MEDAT对2006年TeamDRF的28个空中救援中心（ARC）和联邦警察的6个ARC执行的创伤急诊紧急任务进行评估。区分了在急诊现场已有配备医生的地面紧急医疗服务的联合任务（MEDAT 1组）和没有这种服务的联合任务（MEDAT 2组），并特别调查了两组的救援直升机治疗时间。此外，在海德堡/曼海姆“克里斯托夫53”ARC进行的一项补充性前瞻性区域研究中，调查了2006年5月1日至2007年1月31日期间创伤急诊的联合任务（MAN 1组）和单独任务（MAN 2组）。在两组中，调查了现场参与治疗的所有配备医生的急救系统的总治疗时间。
在全国范围内，可以评估26,010次主要任务，其中11,464次任务是创伤急诊（44.1%），MEDAT 1组执行了2,229次（19.4%），MEDAT 2组执行了9,235次（80.6%）。对于两组，直升机治疗时间取决于损伤的严重程度（NACA分类），MEDAT 1组为17±12分钟（NACA I）至34±19分钟（NACA VII），MEDAT 2组为21±10分钟和36±19分钟（p<0.05，p<0.001）。在MEDAT 1组中，与MEDAT 2组相比，平均治疗时间短2.8分钟（NACA VII）至8.1分钟（NACA VI）。此外，考虑到损伤的严重程度，MEDAT 1组比MEDAT 2组观察到有规律且明显更高的治疗力度（如插管、复位和胸腔置管），以及通过救援直升机转运到诊所的患者比例更高。在区域研究中，评估了670次主要任务，包括382次创伤急诊（57%）。其中，90名多发伤患者（NACA V）在现场未复苏或死亡，MAN
1组58名，MAN 2组32名，并对其进行了更密切的调查。直升机治疗时间与全国性研究中观察到的时间相当，分别为26±12分钟和35±20分钟（p<0.05）。在MAN 1组中，地面救援服务直到直升机到达时的平均治疗时间为22±11分钟；总治疗时间比MAN 2组长48±15分钟和12±8分钟，具有统计学意义。在MAN 1组中，配备医生的地面救援服务到达急诊现场后，直升机平均在17±15分钟后发出警报。MAN 1组中救援直升机团队的治疗明显更广泛。
当配备医生的地面救援团队已到达急诊现场时，直升机的治疗时间缩短了几分钟。然而，必须假定此类任务的院前总时间明显更长。这些结果直接影响急诊调度中心的调度，并表明当需要空中救援将患者送往医院时，应尽早发出直升机警报。在这种情况下，以这种方式启动行动可能会改善重伤患者的预后并节省成本。
