Department of Anesthesiology, VU University Medical Center, Amsterdam, The Netherlands.
Injury. 2012 Nov;43(11):1838-42. doi: 10.1016/j.injury.2012.05.020. Epub 2012 Jun 12.
Prehospital care by physician-based helicopter emergency medical services (P-HEMS) may prolong total prehospital run time. This has raised an issue of debate about the benefits of these services in traumatic brain injury (TBI). We therefore investigated the effects of P-HEMS dispatch on prehospital run time and outcome in severe TBI.
Prehospital run times of 497 patients with severe TBI who were solely treated by a paramedic EMS (n = 125) or an EMS/P-HEMS combination (n = 372) were retrospectively analyzed. Other study parameters included the injury severity score (ISS), Glasgow Coma Scale (GCS), prehospital endotracheal intubation and predicted and observed outcome rates.
Patients who received P-HEMS care were younger and had higher ISS values than solely EMS-treated patients (10%; P = 0.04). The overall prehospital run time was 74 ± 54 min, with similar out-of-hospital times for EMS and P-HEMS treated patients. Prehospital endotracheal intubation was more frequently performed in the P-HEMS group (88%) than in the EMS group (35%; P<0.001). The prehospital run time for intubated patients was similar for P-HEMS (66 (51-80)min) and EMS-treated patients (59 (41-88 min). Unexpectedly, mortality probability scores and observed outcome scores were less favourable for EMS-treated patients when compared to patients treated by P-HEMS.
P-HEMS dispatch does not increase prehospital run times in severe TBI, while it assures prehospital intubation of TBI patients by a well-trained physician. Our data however suggest that a subgroup of the most severely injured patients received prehospital care by an EMS, while international guidelines recommend advanced life support by a physician-based EMS in these cases.
由医师主导的直升机紧急医疗服务（P-HEMS）进行的院前护理可能会延长总院前运行时间。这引发了关于这些服务在创伤性脑损伤（TBI）中益处的争议。因此，我们调查了 P-HEMS 派遣对严重 TBI 的院前运行时间和结果的影响。
回顾性分析了仅由护理人员急救医疗服务（n = 125）或急救医疗服务/ P-HEMS 联合治疗（n = 372）治疗的 497 例严重 TBI 患者的院前运行时间。其他研究参数包括损伤严重程度评分（ISS），格拉斯哥昏迷评分（GCS），院前气管内插管以及预测和观察到的结局率。
接受 P-HEMS 治疗的患者比仅接受 EMS 治疗的患者年轻，ISS 值更高（10％； P = 0.04）。总体院前运行时间为 74 ± 54 分钟，EMS 和 P-HEMS 治疗的患者的院外时间相似。在 P-HEMS 组中进行院前气管内插管的频率（88％）明显高于 EMS 组（35％； P<0.001）。接受插管的患者的院前运行时间在 P-HEMS 组（66（51-80）分钟）和 EMS 治疗的患者中相似（59（41-88）分钟）。出乎意料的是，与接受 P-HEMS 治疗的患者相比，接受 EMS 治疗的患者的死亡率评分和观察到的结局评分较差。
在严重 TBI 中，P-HEMS 派遣不会增加院前运行时间，同时可以确保由经过培训的医师对 TBI 患者进行院前插管。然而，我们的数据表明，一组最严重受伤的患者接受了 EMS 的院前护理，而国际指南建议在这些情况下由医师主导的 EMS 提供高级生命支持。
