From the US Air Force En route Care Research Center/59th MDW/ST-US Army Institute of Surgical Research (J.M., A.G.M., S.S., L.K.R., C.A.P.), JBSA Fort Sam Houston, Texas; Department of Emergency Medicine (J.M.), San Antonio Military Medical Center, JBSA Fort Sam Houston, Texas; Department of Emergency Medicine (V.S.B.), University of Colorado School of Medicine (V.S.B.), Aurora, Colorado; Colorado Air National Guard (V.S.B.), Buckley AFB, Colorado.
J Trauma Acute Care Surg. 2016 Nov;81(5 Suppl 2 Proceedings of the 2015 Military Health System Research Symposium):S104-S110. doi: 10.1097/TA.0000000000001119.
Medical evacuation (MEDEVAC) is the movement and en route care of injured and medically compromised patients by medical care providers via helicopter. Military MEDEVAC platforms provide lifesaving interventions that improve survival in combat. There is limited evidence to support decision making related to en route care and allocation of resources. The association between provider type and en route care is not well understood. Our objective was to describe MEDEVAC providers and identify associations between provider type, procedures performed, and outcomes.
We conducted an institutional review board-approved, retrospective record review of patients traumatically injured in combat, evacuated by MEDEVAC from the point of injury, between 2011 and 2014. Data abstracted included injury description, provider type, procedures performed, medications administered, survival, and 30-day outcomes. Subjects were grouped according to provider type: medics, paramedics, and ADVs (advanced-level providers to include nurses, physician assistants, and physicians). Groups were compared. Analyses were performed using χ tests for categorical variables and analysis of variance tests (Kruskal-Wallis tests) for continuous variables; p < 0.05 was considered significant.
The MEDEVAC records were reviewed, and data were abstracted from 1,237 subjects. The providers were composed of medics, 76%; paramedics, 21%; and ADVs, 4%. Patient and injury demographics were similar among groups. The ADVs were most likely to perform intubation, chest needle decompressions (p < 0.0001), and hypothermia prevention (p = 0.01). Paramedics were most likely to administer blood en route (p < 0.0001). All other procedures were similar between groups. Paramedics were most likely to administer ketamine (p < 0.0001), any analgesic (p < 0.0001), or any medication en route (p < 0.0001). Incidence rates of en route events (pain, hypoxia, abnormal hemodynamics, vital signs) were similar between provider types. In-theater and 30-day survival rates were similar between provider types.
Providers with higher-level training were more likely to perform more advanced procedures during en route care. Our study found no significant association between provider type and in-theater or 30-day mortality rates. Upon subgroup analysis, no difference was found in patients with an injury severity score greater than 16. More evidence is needed to determine the appropriate level of MEDEVAC personnel training and skill maintenance necessary to minimize combat mortality.
Therapeutic study, level III.
医疗后送（MEDEVAC）是指医疗服务提供者通过直升机对受伤和身体状况不佳的患者进行转移和途中护理。军事医疗后送平台提供救生干预措施，可提高战斗中的生存机会。关于途中护理和资源分配的决策，证据有限。提供方类型与途中护理之间的关联尚不清楚。我们的目标是描述医疗后送提供者，并确定提供者类型、实施的程序以及结果之间的关联。
我们对 2011 年至 2014 年间因战斗受伤、通过医疗后送从受伤地点转移的患者进行了机构审查委员会批准的回顾性记录审查。提取的数据包括损伤描述、提供方类型、实施的程序、使用的药物、存活情况和 30 天结果。根据提供方类型将患者分组：医护人员、护理人员和 ADV（包括护士、助理医师和医生在内的高级别提供者）。对各组进行比较。使用卡方检验对分类变量进行分析，使用方差分析检验（Kruskal-Wallis 检验）对连续变量进行分析；p<0.05 被认为具有统计学意义。
审查了医疗后送记录，并从 1237 名患者中提取了数据。提供者由医护人员（76%）、护理人员（21%）和 ADV（4%）组成。各组患者和损伤特征相似。ADV 最有可能进行插管、胸腔针减压（p<0.0001）和预防体温过低（p=0.01）。护理人员最有可能在途中输血（p<0.0001）。各组之间的其他程序相似。护理人员最有可能使用氯胺酮（p<0.0001）、任何镇痛药（p<0.0001）或任何途中用药（p<0.0001）。途中事件（疼痛、缺氧、血流动力学异常、生命体征）的发生率在提供方类型之间相似。在战区和 30 天生存率在提供方类型之间相似。
接受过更高水平培训的提供者在途中护理期间更有可能实施更高级别的程序。我们的研究未发现提供者类型与战区或 30 天死亡率之间存在显著关联。在亚组分析中，损伤严重程度评分大于 16 的患者之间没有差异。需要更多的证据来确定军事医疗后送人员培训和技能维护的适当水平，以最大限度地降低战斗死亡率。
治疗性研究，III 级。
