Pule Marwala Simon, Hodkinson Peter, Hardcastle Timothy
Candidate MPhil Emergency Medicine University of Cape Town.
Division of Emergency Medicine, University of Cape Town.
Afr J Emerg Med. 2022 Sep;12(3):183-190. doi: 10.1016/j.afjem.2022.03.004. Epub 2022 Jun 8.
KwaZulu-Natal, the largest land mass province that is densely populated in SA has vast distances to referral centres and time to definitive treatment is key in trauma care. Helicopter Emergency Medical Service (HEMS) is still an invaluable prehospital asset for the transport of time sensitive trauma. This study reviews the impact of HEMS in the management of trauma at Inkosi Albert Luthuli hospital (IALCH) which is the only public accredited level one trauma centre in the province.
A retrospective descriptive study of polytrauma patients transported by HEMS in KZN to IALCH over a three-year period from 01 January 2014 to 31 December 2016. Data was collected around patient demographics, transfer details and patient outcomes.
Over the three-year period, 117 HEMS transfers were reviewed, with the majority being male (90.6%). Just 26% of HEMS transfers were direct from the scene, with the balance being interhospital transfers largely from distant regional hospitals around the province. Some 60% of injuries were caused by vehicle crashes, and 31% by intentional injury. Mortality was 30% which is reflective of the high severity of injury of the cohort. The injury severity scores (ISS) (median 26 overall) of those who died was higher (median 38) (-= .0002), and there were more interventions before and during transfer such as thoracostomy, ventilation and immobilization. Overall, 88% required admission to ICU at IACLH.
HEMS in the KwaZulu Natal province was mainly used for long-distance transfer of major trauma patients which is an appropriate use of this essential service, given the single major trauma centre in the province. The majority of patients that were transported by HEMS had severe injury, which was also associated with increased mortality outcomes. Rational use of this essential but expensive resource will require clear policy around the role of HEMS and call out criteria in each setting.
夸祖鲁 - 纳塔尔省是南非面积最大且人口密集的省份，距离转诊中心路途遥远，而获得确定性治疗的时间在创伤护理中至关重要。直升机紧急医疗服务（HEMS）对于运送对时间敏感的创伤患者而言，仍是一项极为宝贵的院前资源。本研究回顾了HEMS在因科西·阿尔伯特·卢图利医院（IALCH）创伤管理中的影响，该医院是该省唯一一家经公共认证的一级创伤中心。
对2014年1月1日至2016年12月31日这三年间由HEMS转运至IALCH的多发伤患者进行回顾性描述性研究。收集了患者人口统计学资料、转运细节及患者结局等数据。
在这三年期间，共审查了117例HEMS转运病例，其中大多数为男性（90.6%）。仅有26%的HEMS转运是直接从现场出发，其余则是院际转运，主要来自该省各地偏远的地区医院。约60%的损伤由车祸导致，31%由故意伤害所致。死亡率为30%，这反映了该队列损伤的高度严重性。死亡患者的损伤严重程度评分（ISS）（总体中位数为26）更高（中位数为38）（P = 0.0002），并且在转运前和转运期间有更多的干预措施，如胸腔造口术、通气和固定。总体而言，88%的患者需要入住IALCH的重症监护病房。
鉴于该省仅有一家主要创伤中心，夸祖鲁 - 纳塔尔省的HEMS主要用于重伤患者的长途转运，这是对这项重要服务的合理应用。大多数由HEMS转运的患者伤势严重，这也与更高的死亡率相关。合理使用这项重要但昂贵的资源需要围绕HEMS的作用及各情况下的出诊标准制定明确的政策。
