Nolan Brodie, Tien Homer, Sawadsky Bruce, Rizoli Sandro, McFarlan Amanda, Phillips Andrea, Ackery Alun
Prehosp Emerg Care. 2017 May-Jun;21(3):327-333. doi: 10.1080/10903127.2016.1263371. Epub 2017 Jan 19.
Helicopter emergency medical services (HEMS) have become an engrained component of trauma systems. In Ontario, transportation for trauma patients is through one of three ways: scene call, modified scene call, or interfacility transfer. We hypothesize that differences exist between these types of transports in both patient demographics and patient outcomes. This study compares the characteristics of patients transported by each of these methods to two level 1 trauma centers and assesses for any impact on morbidity or mortality. As a secondary outcome reasons for delay were identified.
A local trauma registry was used to identify and abstract data for all patients transported to two trauma centers by HEMS over a 36-month period. Further chart abstraction using the HEMS patient care reports was done to identify causes of delay during HEMS transport.
During the study period HEMS transferred a total of 911 patients of which 139 were scene calls, 333 were modified scene calls and 439 were interfacility transfers. Scene calls had more patients with an ISS of less than 15 and had more patients discharged home from the ED. Modified scene calls had more patients with an ISS greater than 25. The most common delays that were considered modifiable included the sending physician doing a procedure, waiting to meet a land EMS crew, delays for diagnostic imaging and confirming disposition or destination.
Differences exist between the types of transports done by HEMS for trauma patients. Many identified reasons for delay to HEMS transport are modifiable and have practical solutions. Future research should focus on solutions to identified delays to HEMS transport. Key words: helicopter emergency medical services; trauma; prehospital care; delays.
直升机紧急医疗服务（HEMS）已成为创伤系统中不可或缺的一部分。在安大略省，创伤患者的转运方式有三种：现场呼叫、改良现场呼叫或机构间转运。我们假设这些转运类型在患者人口统计学特征和患者结局方面存在差异。本研究比较了通过这些方法转运至两个一级创伤中心的患者特征，并评估了对发病率或死亡率的任何影响。作为次要结果，确定了延误的原因。
使用当地创伤登记册识别并提取在36个月期间通过HEMS转运至两个创伤中心的所有患者的数据。使用HEMS患者护理报告进一步提取病历，以确定HEMS转运期间的延误原因。
在研究期间，HEMS共转运了911名患者，其中139例为现场呼叫，333例为改良现场呼叫，439例为机构间转运。现场呼叫的患者中，损伤严重度评分（ISS）小于15的更多，且从急诊科出院回家的患者更多。改良现场呼叫的患者中，ISS大于25的更多。被认为可改变的最常见延误包括发送医生进行操作、等待与地面急救医疗服务人员会合、诊断成像延误以及确认处置或目的地。
HEMS对创伤患者的转运类型之间存在差异。许多已确定的HEMS转运延误原因是可以改变的，并且有实际的解决方案。未来的研究应侧重于解决已确定的HEMS转运延误问题。关键词：直升机紧急医疗服务；创伤；院前护理；延误。
