Dieppe Clare, Lo T Y Milly, McFadzean Jillian, Rowney David A
Emergency Department, The Children's Hospital at Westmead, Locked Bag 4001, Parramatta, Sydney, NSW, 2145, Australia.
Intensive Care Med. 2009 Feb;35(2):334-8. doi: 10.1007/s00134-008-1323-1. Epub 2008 Oct 15.
This feasibility study aimed to determine the maximum theoretical distance the Edinburgh Paediatric Retrieval Team (EPRT) could travel to retrieve head injured children without additional delay in reaching definitive care.
A prospective audit was conducted over 2 years to determine the current practice for paediatric head injury transfers (stabilisation, referral, and transfer time) undertaken by primary hospital staff, and the performance (mobilisation and travel time) of the EPRT. A novel formula was devised and used to determine the theoretical maximum radius within which the EPRT could reach a referring hospital during their stabilisation of head injured patients.
During the study period, 27 head injured patients were transferred to our unit by road and the EPRT conducted 194 road retrievals. The median stabilisation time for the head injured patients was 3.6 h. Median time to refer these patients to neurosurgical services was 1 h after presenting to primary hospitals. Median mobilisation time for EPRT was 1 h. Using our novel formula, 67 miles was the theoretical maximum radius within which the EPRT could reach a referring hospital during their stabilisation of head injured patients.
Specialist team retrieval of paediatric head injury is a possibility, but not without significant organisational changes such as availability of second teams, early referral of patients and utilisation of the mobilisation time as a cancellation window. Our novel formula offers other teams a starting point to assess their own performance and to develop services.
本可行性研究旨在确定爱丁堡儿科救援团队（EPRT）在不额外延迟到达最终治疗的情况下，前往救治头部受伤儿童的最大理论距离。
进行了一项为期2年的前瞻性审计，以确定基层医院工作人员进行儿科头部损伤转运（稳定、转诊和转运时间）的当前做法，以及EPRT的表现（动员和出行时间）。设计并使用了一个新公式来确定EPRT在稳定头部受伤患者期间能够到达转诊医院的理论最大半径。
在研究期间，27名头部受伤患者通过公路被转运至我们科室，EPRT进行了194次公路救援。头部受伤患者的中位稳定时间为3.6小时。这些患者转诊至神经外科服务的中位时间是在到达基层医院后1小时。EPRT的中位动员时间为1小时。使用我们的新公式，67英里是EPRT在稳定头部受伤患者期间能够到达转诊医院的理论最大半径。
专科团队对儿科头部损伤进行救援是有可能的，但需要进行重大的组织变革，如配备第二支团队、患者早期转诊以及将动员时间用作取消窗口。我们的新公式为其他团队评估自身表现和发展服务提供了一个起点。
