CareFlight, PO Box 159, Barden St, Northmead, NSW 2145, Australia.
Scand J Trauma Resusc Emerg Med. 2012 Dec 18;20:82. doi: 10.1186/1757-7241-20-82.
Severe paediatric trauma patients benefit from direct transport to dedicated Paediatric Trauma Centres (PTC). Parallel case identification systems utilising paramedics from a centralised dispatch centre versus the crew of a physician staffed Helicopter Emergency Medical Service (HEMS) allowed comparison of the two systems for case identification rates and subsequent timeliness of direct transfer to a PTC.
Paediatric trauma patients over a two year period from the Sydney region with an Injury Severity Score (ISS) > 15 were retrospectively identified from a state wide trauma registry. Overall paediatric trauma system performance was assessed by comparisons of the availability of the physician staffed HEMS for patient characteristics, transport mode (direct versus indirect) and the times required for the patient to arrive at the paediatric trauma centre. The proportion of patients transported directly to a PTC was compared between the times that the HEMS service was available versus the time that it was unavailable to determine if the HEMS system altered the rate of direct transport to a PTC. Analysis of variance was used to compare the identifying systems for various patient characteristics when the HEMS was available.
Ninety nine cases met the inclusion criteria, 44 when the HEMS system was operational. Patients identified for physician response by the HEMS system were significantly different to those that were not identified with higher median ISS (25 vs 18, p = 0.011), and shorter times to PTC (67 vs 261mins, p = 0.015) and length of intensive care unit stays (2 vs 0 days, p = 0.045). Of the 44 cases, 21 were not identified, 3 were identified by the paramedic system and 20 were identified by the HEMS system, (P < 0.001). Direct transport to a PTC was more likely to occur when the HEMS dispatch system was available (RR 1.81, 95% CI 1.20-2.73). The median time (minutes) to arrival at the PTC was shorter when HEMS available (HEMS available 92, IQR 50-261 versus HEMS unavailable 296, IQR 84-583, P < 0.01).
Physician staffed HEMS crew dispatch is significantly more likely to identify cases of severe paediatric trauma and is associated with a greater proportion of transports directly to a PTC and with faster times to arrival.
严重儿科创伤患者受益于直接转运至专门的儿科创伤中心（PTC）。利用来自集中调度中心的护理人员与配备医生的直升机紧急医疗服务（HEMS）机组人员并行的病例识别系统，可比较两种系统的病例识别率以及随后直接转至 PTC 的及时性。
从新南威尔士州的全州创伤登记处回顾性确定了过去两年中受伤严重程度评分（ISS）> 15 的儿科创伤患者。通过比较配备医生的 HEMS 对患者特征、转运方式（直接与间接）和患者到达儿科创伤中心所需时间的可用性，评估整体儿科创伤系统的性能。在 HEMS 服务可用与不可用的时间段之间比较直接转运至 PTC 的患者比例，以确定 HEMS 系统是否改变了直接转运至 PTC 的比例。当 HEMS 可用时，使用方差分析比较识别系统对各种患者特征的差异。
99 例符合纳入标准，其中 44 例在 HEMS 系统运行时符合纳入标准。通过 HEMS 系统识别出需要医生响应的患者与未识别出的患者相比，ISS 中位数明显更高（25 与 18，p=0.011），到达 PTC 的时间更短（67 与 261 分钟，p=0.015），重症监护病房住院时间更短（2 与 0 天，p=0.045）。在 44 例患者中，有 21 例未被识别，3 例被护理人员系统识别，20 例被 HEMS 系统识别（P<0.001）。当 HEMS 调度系统可用时，更有可能直接转运至 PTC（RR 1.81，95%CI 1.20-2.73）。当 HEMS 可用时，到达 PTC 的中位数时间（分钟）更短（HEMS 可用 92，IQR 50-261 与 HEMS 不可用 296，IQR 84-583，P<0.01）。
配备医生的 HEMS 机组人员调度更有可能识别严重儿科创伤病例，并与更高比例的直接转运至 PTC 以及更快的到达时间相关。
