Norton R, Wortman E, Eastes L, Daya M, Hedges J, Hoyt J
Department of Emergency Medicine, Oregon Health Sciences University, Portland 97201-3098, USA.
J Trauma. 1996 Nov;41(5):886-91. doi: 10.1097/00005373-199611000-00022.
Inappropriate use of helicopter transport of trauma patients in urban areas increases costs, risk of injury, and unavailability for appropriate flights. We evaluated the effect of an emergency medical service (EMS) system audit of helicopter trauma scene flights (TSFs) on appropriateness of TSFs.
Retrospective cohort.
Defined urban area with two Level I trauma hospitals.
Consecutive TSFs 2 years before (PRE) and 2 years after (POST) audit.
EMS system audit established criteria for appropriate TSFs.
The total number of trauma system entries were similar for the two periods: PRE (1989) = 2862; POST (1990 and 1991) = 2787 and 2772. The total number of TSFs decreased after audit (PRE = 122; POST = 50). The proportion of inappropriate (INAPPRO)/total TSFs did not change (62% vs. 66%; chi 2 = 0.04; p = 0.85). There was no difference between appropriate (APPRO) and INAPPRO TSFs for mean vital signs, mechanism of injury, Trauma and Injury Severity Score (TRISS) and Injury Severity Score (ISS), mean length of stay, and proportion of survivors. Scene and transport time intervals were similar. For both PRE and POST periods, 26 APPRO patients (45%) were admitted to non-intensive care unit wards.
An EMS system audit with general awareness of audit criteria decreased the total number of TSFs and hence the number of INAPPRO TSFs in this urban trauma system population. However, the proportion of TSFs that were considered INAPPRO did not change. Criteria for urban TSFs should be based on markers of critical physiologic patient status matched to unique care that the helicopter personnel can provide (e.g., advanced airway management).
在城市地区，对创伤患者不恰当使用直升机转运会增加成本、受伤风险，并导致无法进行合适的飞行任务。我们评估了紧急医疗服务（EMS）系统对直升机创伤现场飞行（TSF）进行审核对TSF适宜性的影响。
回顾性队列研究。
设有两家一级创伤医院的特定城市区域。
审核前2年（PRE）和审核后2年（POST）的连续TSF病例。
EMS系统审核确定了合适TSF的标准。
两个时期创伤系统登记的总数相似：PRE（1989年）=2862例；POST（1990年和1991年）=2787例和2772例。审核后TSF的总数减少（PRE = 122例；POST = 50例）。不恰当（INAPPRO）/TSF总数的比例没有变化（62%对66%；χ² = 0.04；p = 0.85）。在平均生命体征、损伤机制、创伤和损伤严重程度评分（TRISS）以及损伤严重程度评分（ISS）、平均住院时间和幸存者比例方面，恰当（APPRO）和INAPPRO的TSF之间没有差异。现场和转运时间间隔相似。对于PRE和POST两个时期，26例APPRO患者（45%）被收治到非重症监护病房。
进行具有审核标准普遍认知的EMS系统审核，减少了该城市创伤系统人群中TSF的总数，从而减少了INAPPRO TSF的数量。然而，被认为是INAPPRO的TSF比例没有变化。城市TSF的标准应基于与直升机人员能够提供的独特护理相匹配的关键生理患者状态指标（例如，高级气道管理）。
