Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon; University of Ljubljana, Ljubljana, Slovenia.
Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
J Emerg Med. 2020 Dec;59(6):884-893. doi: 10.1016/j.jemermed.2020.08.004. Epub 2020 Sep 29.
Helicopter Emergency Medical Services (HEMS) dispatch currently depends on predefined protocols, on first responders' initial assessment, or on medical direction decision in some states. National guidelines do not provide recommendations concerning prehospital time criteria.
Our aim was to investigate the association between the mode of transportation (HEMS vs. ground EMS [GEMS]) and survival of adult patients with blunt trauma across different prehospital time intervals.
This retrospective matched cohort study was carried out using the 2015 National Trauma Data Bank (NTDB) dataset. Adult patients with blunt injuries transported via HEMS were selected and matched (1 to 1) for 13 variables to those who were transported by GEMS. Survival rates were calculated for the two groups across different prehospital time intervals.
Patients transported by HEMS (n = 16,269) were compared with those transported by GEMS (n = 16,269). Most patients were aged 16 to 64 years (84.0%), male (69.4%), and white (88.0%). Overall survival rate to hospital discharge was significantly higher in the HEMS group (96.8% vs. 96.2%; p = 0.002). Patients transported by HEMS had higher survival rates in the ≤ 30-min interval (97.7% vs. 93.2%; p = 0.004); GEMS patients had higher survival rates in the 61- to 90-min interval (97.4% vs. 96.5%; p = 0.038). No difference in survival rates between the two groups was observed in intervals > 90 min.
In adult patients with blunt trauma, HEMS transport was associated with overall improved survival rates mainly in the first 30 min after injury. GEMS transport, however, had a survival advantage in the 61- to 90-min total prehospital time interval.
直升机紧急医疗服务（HEMS）的派遣目前取决于预设的协议、一线急救人员的初步评估，或在某些州取决于医疗指导决策。国家指南并未提供有关院前时间标准的建议。
我们旨在研究在不同院前时间间隔内，与地面紧急医疗服务（GEMS）相比，成人钝性创伤患者的交通方式（HEMS 与 GEMS）与存活率之间的关联。
本回顾性匹配队列研究使用了 2015 年国家创伤数据库（NTDB）数据集。选择并匹配了通过 HEMS 转运的成人钝性创伤患者（1 比 1），以匹配通过 GEMS 转运的患者。计算了两组在不同院前时间间隔内的存活率。
将通过 HEMS 转运的患者（n=16269）与通过 GEMS 转运的患者（n=16269）进行比较。大多数患者年龄在 16 至 64 岁之间（84.0%），男性（69.4%），白人（88.0%）。HEMS 组的总体存活率到出院时显著更高（96.8%比 96.2%；p=0.002）。在≤30 分钟的间隔内，通过 HEMS 转运的患者存活率更高（97.7%比 93.2%；p=0.004）；GEMS 患者在 61 至 90 分钟的间隔内的存活率更高（97.4%比 96.5%；p=0.038）。在>90 分钟的间隔内，两组之间的存活率没有差异。
在成人钝性创伤患者中，HEMS 转运与总体存活率的提高有关，主要是在受伤后的前 30 分钟内。然而，在 61 至 90 分钟的总院前时间间隔内，GEMS 转运具有生存优势。
