US Army Institute of Surgical Research, Fort Sam Houston, San Antonio, Texas 78234-6315, USA.
J Trauma Acute Care Surg. 2012 Aug;73(2 Suppl 1):S32-7. doi: 10.1097/TA.0b013e3182606001.
The US Army pioneered medical evacuation (MEDEVAC) by helicopter, yet its system remains essentially unchanged since the Vietnam era. Care is provided by a single combat medic credentialed at the Emergency Medical Technician - Basic level. Treatment protocols, documentation, medical direction, and quality improvement processes are not standardized and vary significantly across US Army helicopter evacuation units. This is in contrast to helicopter emergency medical services that operate within the United States. Current civilian helicopter evacuation platforms are routinely staffed by critical care-trained flight paramedics (CCFP) or comparably trained flight nurses who operate under trained EMS physician medical direction using formalized protocols, standardized patient care documentation, and rigorous quality improvement processes. This study compares mortality of patients with injury from trauma between the US Army's standard helicopter evacuation system staffed with medics at the Emergency Medical Technician - Basic level (standard MEDEVAC) and one staffed with experienced CCFP using adopted civilian helicopter emergency medical services practices.
This is a retrospective study of a natural experiment. Using data from the Joint Theater Trauma Registry, 48-hour mortality for severely injured patients (injury severity score ≥ 16) was compared between patients transported by standard MEDEVAC units and CCFP air ambulance units.
The 48-hour mortality for the CCFP-treated patients was 8% compared to 15% for the standard MEDEVAC patients. After adjustment for covariates, the CCFP system was associated with a 66% lower estimated risk of 48-hour mortality compared to the standard MEDEVAC system.
These findings demonstrate that using an air ambulance system based on modern civilian helicopter EMS practice was associated with a lower estimated risk of 48-hour mortality among severely injured patients in a combat setting.
美国陆军率先采用直升机实施医疗后送（MEDEVAC），但其系统自越南时代以来基本保持不变。由一名具有基本急救技术员认证的战斗军医提供医疗服务。治疗方案、文件、医疗指导和质量改进流程并未标准化，并且在各美国陆军直升机后送单位之间差异很大。这与在美国运营的直升机紧急医疗服务形成鲜明对比。目前，民用直升机紧急医疗服务平台通常配备有受过重症监护培训的飞行护理人员（CCFP）或受过类似培训的飞行护士，他们在经过培训的急诊医师医疗指导下，使用正式的方案、标准化的患者护理文件和严格的质量改进流程进行操作。本研究比较了由基本急救技术员（标准 MEDEVAC）和经验丰富的 CCFP 人员组成的美军标准直升机后送系统与采用民用直升机紧急医疗服务实践的直升机后送系统治疗创伤后伤员的死亡率。
这是一项自然实验的回顾性研究。使用来自联合战区创伤登记处的数据，比较了严重受伤患者（损伤严重程度评分≥16）在标准 MEDEVAC 单位和 CCFP 空中救护单位转运后的 48 小时死亡率。
CCFP 治疗患者的 48 小时死亡率为 8%，而标准 MEDEVAC 患者为 15%。在调整了协变量后，CCFP 系统与标准 MEDEVAC 系统相比，48 小时死亡率的估计风险降低了 66%。
这些发现表明，在战斗环境中，使用基于现代民用直升机紧急医疗服务实践的空中救护系统与严重受伤患者的 48 小时死亡率降低估计风险相关。
