Den Hartog Dennis, Romeo Jamie, Ringburg Akkie N, Verhofstad Michael H J, Van Lieshout Esther M M
Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Injury. 2015 Jul;46(7):1281-6. doi: 10.1016/j.injury.2015.04.013. Epub 2015 Apr 14.
Physician-staffed Helicopter Emergency Medical Services (HEMS) provide specialist medical care to the accident scene and aim to improve survival of severely injured patients. Previous studies were often underpowered and showed heterogeneous results, leaving the subject at debate. The aim of this retrospective, adequately powered, observational study was to determine the effect of physician-staffed HEMS assistance on survival of severely injured patients.
All consecutive severely injured trauma patients (ISS >15) between October 1, 2000 and February 28, 2013 were included. Assistance of physician-staffed HEMS was compared with assistance from the ambulance paramedic crew (i.e., EMS group) only. A regression model was constructed for calculating the expected survival and survival benefit.
A total of 3543 polytraumatised patients with an ISS >15 were treated at the Emergency Department, of whom 2176 patients remained for analysis; 1495 (69%) were treated by EMS only and 681 (31%) patients received additional pre-hospital care of HEMS. The model with the best fit and diagnostic properties (H-L coefficient 2.959, p=0.937; AUC 0.888; PPV 71.4%; NPV 88.0%) calculated that 36 additional patients survived because of HEMS assistance. This resulted in an average of 5.33 additional lives saved per 100 HEMS dispatches for severely injured patients.
The present study indicates an additional 5.33 lives saved per 100 dispatches of the physician-staffed HEMS. Given the excellent statistical power of this study (>90%), physician-staffed HEMS is confirmed to be an evidence-based valuable addition to the EMS systems in saving lives of severely injured patients.
配备医生的直升机紧急医疗服务（HEMS）为事故现场提供专科医疗护理，旨在提高重伤患者的生存率。以往的研究往往样本量不足，结果也参差不齐，这一问题仍存在争议。这项回顾性、样本量充足的观察性研究的目的是确定配备医生的HEMS援助对重伤患者生存的影响。
纳入2000年10月1日至2013年2月28日期间所有连续的重伤创伤患者（损伤严重度评分[ISS]>15）。将配备医生的HEMS援助与仅由救护车护理人员提供的援助（即急救医疗服务[EMS]组）进行比较。构建回归模型以计算预期生存率和生存获益。
共有3543例ISS>15的多发伤患者在急诊科接受治疗，其中2176例患者留作分析；1495例（69%）仅接受EMS治疗，681例（31%）患者接受了额外的HEMS院前护理。拟合度和诊断性能最佳的模型（H-L系数2.959，p=0.937；曲线下面积[AUC]0.888；阳性预测值[PPV]71.4%；阴性预测值[NPV]88.0%）计算得出，由于HEMS援助，多挽救了36例患者的生命。这意味着每100次为重伤患者派遣HEMS，平均多挽救5.33条生命。
本研究表明，每100次派遣配备医生的HEMS可多挽救5.33条生命。鉴于本研究具有出色的统计学效力（>90%），证实配备医生的HEMS是EMS系统中基于证据的、对挽救重伤患者生命有价值的补充。
