Abe Tomohiro, Nagano Takehiko, Ochiai Hidenobu
Department of Trauma and Critical Care Medicine, University of Miyazaki Hospital, Japan.
J Rural Med. 2017 May;12(1):12-19. doi: 10.2185/jrm.2919. Epub 2017 May 24.
Involvement of all regional medical facilities in a trauma system is challenging in rural regions. We hypothesized that the physician-staffed helicopter emergency medical service potentially encouraged local facilities to participate in trauma systems by providing the transport of patients with trauma to those facilities in a rural setting. We performed two retrospective observational studies. First, yearly changes in the numbers of patients with trauma and destination facilities were surveyed using records from the Miyazaki physician-staffed helicopter emergency medical service from April 2012 to March 2014. Second, we obtained data from medical records regarding the mechanism of injury, severity of injury, resuscitative interventions performed within 24 h after admission, secondary transports owing to undertriage by attending physicians, and deaths resulting from potentially preventable causes. Data from patients transported to the designated trauma center and those transported to non-designated trauma centers in Miyazaki were compared. In total, 524 patients were included. The number of patients transported to non-designated trauma centers and the number of non-designated trauma centers receiving patients increased after the second year. We surveyed 469 patient medical records (90%). There were 194 patients with major injuries (41%) and 104 patients with multiple injuries (22%), and 185 patients (39%) received resuscitative interventions. The designated trauma centers received many more patients with trauma (366 vs. 103), including many more patients with major injuries (47% vs. 21%, < 0.01) and multiple injuries (25% vs. 13%, < 0.01), than the non-designated trauma centers. The number of patients with major injuries and patients who received resuscitative interventions increased for non-designated trauma centers after the second year. There were 9 secondary transports and 26 deaths. None of these secondary transports resulted from undertriage by staff physicians and none of these deaths resulted from potentially preventable causes. The rural physician-staffed helicopter emergency medical service potentially encouraged non-designated trauma centers to participate in trauma systems while maintaining patient safety.
在农村地区，让所有区域医疗设施都参与创伤系统颇具挑战性。我们推测，配备医师的直升机紧急医疗服务可能通过在农村环境中将创伤患者转运至当地设施，从而鼓励当地设施参与创伤系统。我们进行了两项回顾性观察研究。首先，利用2012年4月至2014年3月宫崎县配备医师的直升机紧急医疗服务记录，调查创伤患者数量和目的地设施的年度变化。其次，我们从医疗记录中获取了有关损伤机制、损伤严重程度、入院后24小时内实施的复苏干预措施、因主治医生分诊不足导致的二次转运以及潜在可预防原因导致的死亡的数据。比较了宫崎县被转运至指定创伤中心的患者和被转运至非指定创伤中心的患者的数据。总共纳入了524例患者。第二年之后，被转运至非指定创伤中心的患者数量以及接收患者的非指定创伤中心数量均有所增加。我们调查了469份患者医疗记录（90%）。有194例重伤患者（41%）和104例多发伤患者（22%），185例患者（39%）接受了复苏干预。与非指定创伤中心相比，指定创伤中心接收的创伤患者更多（366例对103例），包括更多的重伤患者（47%对21%，P<0.01）和多发伤患者（25%对13%，P<0.01）。第二年之后，非指定创伤中心的重伤患者数量和接受复苏干预的患者数量有所增加。有9例二次转运和26例死亡。这些二次转运均非由 staff physicians 分诊不足导致，这些死亡均非由潜在可预防原因导致。农村配备医师的直升机紧急医疗服务可能在维持患者安全的同时，鼓励非指定创伤中心参与创伤系统。 （注：原文中“staff physicians”表述不太准确，结合语境推测可能是“主治医生”之类的意思，这里保留原文未做准确翻译）
