Tiamfook-Morgan Tami O, Kociszewski Christine, Browne Ciaran, Barclay Derek, Wedel Suzanne K, Thomas Stephen H
Harvard Affiliated Emergency Medicine Residency Program and Massachusetts General Hospital, Boston, Massachusetts 02114-2241, USA.
Prehosp Emerg Care. 2008 Oct-Dec;12(4):443-50. doi: 10.1080/10903120802290794.
Our state has consensus guides for helicopter emergency medical services (HEMS) scene dispatch, based on physiologic, anatomic, and special criteria (e.g., ejection from a vehicle, age < 10 or > 55 years). There has been much attention paid to improving HEMS triage criteria, but less focus on whether current HEMS uses meet existing criteria.
To assess a HEMS program's compliance with regional air medical dispatch guidelines and to identify factors associated with noncompliant flights.
Using chart review and discussion with referring agencies, we conducted a consecutive case review of a HEMS program's initial 100 flights in one year (2005), collecting data pertinent to triage, prehospital times, and hospital course. Analysis (p = 0.05) of the outcome "met triage criteria" (MTC) used Kruskal-Wallis and Fisher's exact tests. Logistic regression, reporting odds ratios (ORs) with 95% confidence intervals (CIs), was used to adjust for covariates while assessing predictors of the dichotomous outcome MTC. The predictors assessed included demographics, advanced life support (ALS) scene presence, and whether transports occurred during rush hours (0700-1000 and 1600-1900).
The 100 patients (98 blunt trauma; 73% male) from four Massachusetts emergency medical services (EMS) regions (n = 94) and New Hampshire (n = 6) were classified as MTC in 73% of cases. Physiologic criteria were met in 19% of cases (they were the sole criterion met in one case), anatomic criteria in 49% (sole criterion n = 24), and special criteria in 67% (sole criterion n = 15). There was no association between MTC status and age (p = 0.98), gender (p = 0.39), rush-hour transport (p = 0.81), or ALS-trained ground EMS presence on scene (p = 0.98). Analysis adjusting for transport distance and injury mechanism identified an association between EMS region and MTC transport status (p = 0.006); regions' likelihoods of MTC proportions ranged from 50% to 94%.
Despite promulgation of consensus guidelines, nearly a fourth of HEMS transports were non-MTC. Wide interregional variation in the likelihood of MTC HEMS use provides a focus for further research/education. Regional systems should strive not only for the refinement of, but also the compliance with, HEMS triage guidelines.
我们所在的州有基于生理、解剖和特殊标准（如从车辆中弹出、年龄小于10岁或大于55岁）的直升机紧急医疗服务（HEMS）现场调度共识指南。人们对改进HEMS分诊标准给予了很多关注，但对当前HEMS的使用是否符合现有标准关注较少。
评估一个HEMS项目对区域空中医疗调度指南的遵守情况，并确定与不符合标准飞行相关的因素。
通过病历审查和与转诊机构的讨论，我们对一个HEMS项目在一年（2005年）内的最初100次飞行进行了连续病例审查，收集了与分诊、院前时间和住院过程相关的数据。对“符合分诊标准”（MTC）这一结果进行分析（p = 0.05）时使用了Kruskal-Wallis检验和Fisher精确检验。在评估二分结果MTC的预测因素时，使用逻辑回归报告比值比（OR）及95%置信区间（CI），并对协变量进行调整。评估的预测因素包括人口统计学特征、现场高级生命支持（ALS）的存在情况以及运输是否在高峰时段（0700 - 1000和1600 - 1900）进行。
来自马萨诸塞州四个紧急医疗服务（EMS）地区（n = 94）和新罕布什尔州（n = 6）的100名患者（98例钝性创伤；男性占73%）中,73%的病例被归类为符合MTC。19%的病例符合生理标准（其中一例是唯一符合的标准），49%符合解剖标准（唯一标准的病例数n = 24），67%符合特殊标准（唯一标准的病例数n = 15）。MTC状态与年龄（p = 0.98）、性别（p = 0.39）、高峰时段运输（p = 0.81）或现场有接受ALS培训的地面EMS人员（p = 0.98）之间无关联。在对运输距离和损伤机制进行调整分析后，发现EMS地区与MTC运输状态之间存在关联（p = 0.006）；各地区MTC比例的可能性范围为50%至94%。
尽管发布了共识指南，但近四分之一的HEMS运输不符合MTC。MTC HEMS使用可能性在区域间存在很大差异，这为进一步研究/教育提供了重点。区域系统不仅应努力完善HEMS分诊指南，还应努力遵守这些指南。
