Integrating transportation data with emergency medical service records to improve triage decision of high-risk trauma patients

2021 ◽  
Vol 22 ◽  
pp. 101106
Author(s):  
Chenfeng Xiong ◽  
Mofeng Yang ◽  
Rosemary Kozar ◽  
Lei Zhang
Keyword(s):  
High Risk ◽  
Emergency Medical Service ◽  
Medical Service ◽  
Trauma Patients ◽  
Triage Decision ◽  
Emergency Medical

Utilization Criteria for Prehospital Ultrasound in a Canadian Critical Care Helicopter Emergency Medical Service: Determining Who Might Benefit

2017 ◽  
Vol 32 (5) ◽  
pp. 536-540 ◽  
Author(s):  
Domhnall O’Dochartaigh ◽  
Matthew Douma ◽  
Chris Alexiu ◽  
Shell Ryan ◽  
Mark MacKenzie
Keyword(s):  
Critical Care ◽  
Emergency Medical Service ◽  
Medical Service ◽  
Helicopter Emergency Medical Service ◽  
Outcome Variable ◽  
Trauma Patients ◽  
Medical Patients ◽  
Shock Index ◽  
Patient Acuity ◽  
Emergency Medical

AbstractIntroductionPrehospital ultrasound (PHUS) assessments by physicians and non-physicians are performed on medical and trauma patients with increasing frequency. Prehospital ultrasound has been shown to be of benefit by supporting interventions.ProblemWhich patients may benefit from PHUS has not been clearly identified.MethodsA multi-variable logistic regression analysis was performed on a previously created retrospective dataset of five years of physician- and non-physician-performed ultrasound scans in a Canadian critical care Helicopter Emergency Medical Service (HEMS). For separate medical and trauma patient groups, the a-priori outcome assessed was patient characteristics associated with the outcome variable of “PHUS-supported intervention.”ResultsBoth models were assessed (Likelihood Ratio, Score, and Wald) as a good fit. For medical patients, the characteristics of heart rate (HR) and shock index (SI) were found to be most significant for an intervention being supported by PHUS. An extremely low HR was found to be the most significant (OR=15.86 [95% confidence interval (CI), 1.46-171.73]; P=.02). The higher the SI, the more likely that an intervention was supported by PHUS (SI 0.9 to<1.3: OR=9.15 [95% CI, 1.36-61.69]; P=.02; and SI 1.3+: OR=8.37 [95% CI, 0.69-101.66]; P=.09). For trauma patients, the characteristics of Prehospital Index (PHI) and SI were found to be most significant for PHUS support. The greatest effect was PHI, where increasing ORs were seen with increasing PHI (PHI 14-19: OR=13.36 [95% CI, 1.92-92.81]; P=.008; and PHI 20-24: OR=53.10 [95% CI, 4.83-583.86]; P=.001). Shock index was found to be similar, though, with lower impact and significance (SI 0.9 to<1.3: OR=9.11 [95% CI, 1.31-63.32]; P=.025; and SI 1.3+: OR=35.75 [95% CI, 2.51-509.81]; P=.008).Conclusions:In a critical care HEMS, markers of higher patient acuity in both medical and trauma patients were associated with occurrences when an intervention was supported by PHUS. Prospective study with in-hospital follow-up is required to confirm these hypothesis-generating results.O’DochartaighD, DoumaM, AlexiuC, RyanS, MacKenzieM. Utilization criteria for prehospital ultrasound in a Canadian critical care Helicopter Emergency Medical Service: determining who might benefit. Prehosp Disaster Med. 2017;32(5):536–540.

Emergency Medical Service Transport Time and Trauma Outcomes at an Urban Level 1 Trauma Center: Evaluation of Prehospital Emergency Medical Service Response

2021 ◽  
pp. 000313482098882
Author(s):  
Adel Elkbuli ◽  
Brianna Dowd ◽  
Carol Sanchez ◽  
Saamia Shaikh ◽  
Mason Sutherland ◽  
...  
Keyword(s):  
Emergency Medical Service ◽  
Trauma Center ◽  
Medical Service ◽  
Injury Severity ◽  
Future Research ◽  
Trauma Patients ◽  
Transport Time ◽  
Emergency Medical ◽  
Level 1 ◽  
Level 1 Trauma Center

Background The use of helicopter emergency medical services (HEMS) for trauma patients has been debated since its introduction. We aim to compare outcomes for trauma patients transported by ground EMS (GEMS) vs. HEMS using raw and adjusted mortality in a level 1 trauma center. Methods A 6-year retrospective cohort study utilizing our level 1 trauma center registry for patients transferred by GEMS or HEMS was performed. Demographics and outcome measures were compared. Raw and adjusted mortality was evaluated. Adjusted mortality was determined incorporating confounders, including patient demographics, comorbid conditions, mechanism of injury, injury severity score (ISS), Glasgow Coma Scale score, and EMS transport time. Chi-square, multivariable logistic regression, and independent sample T-test were utilized with significance, defined as P < .05. Results Of 12 633 patients, 10 656 were transported via GEMS and 1977 with HEMS. Mean age was 55 for GEMS and 40 for HEMS ( P < .001). Mean ISS was 9.29 and 11.73 for GEMS and HEMS ( P < .001). Mean Revised Trauma Score was higher (less severe) for GEMS vs. HEMS (7.6 vs. 7.12, P < .001). Mean transport times for GEMS and HEMS was 39.45 vs. 47.29 minutes ( P = .02). Raw mortality was 2.55% (307/10 656) for GEMS and 6.78% (134/1977) for HEMS. Adjusted mortality revealed a 16.6% increased mortality for GEMS compared to HEMS (adjusted odds ratio = 1.166, 95% CI: .815-1.668). Conclusions Air-lifted trauma patients were younger, more severely injured, and more hemodynamically unstable and required longer transport time but experienced lower adjusted mortality. Future research is needed to investigate whether reducing transport times and augmenting the advanced care already implemented by HEMS crews can improve outcomes.

scholarly journals Mechanical Chest Compression Devices in the Helicopter Emergency Medical Service in Switzerland

2020 ◽  
Author(s):  
Urs Pietsch ◽  
David Reiser ◽  
Volker Wenzel ◽  
Jürgen Knapp ◽  
Mario Tissi ◽  
...  
Keyword(s):  
Emergency Medical Service ◽  
Chest Compression ◽  
Medical Service ◽  
Service Providers ◽  
Helicopter Emergency Medical Service ◽  
Spontaneous Circulation ◽  
Trauma Patients ◽  
Medical Systems ◽  
Mechanical Chest Compression ◽  
Emergency Medical

Abstract Background Over the past years, several emergency medical service providers have introduced mechanical chest compression devices (MCDs) in their protocols for cardiopulmonary resuscitation (CPR). Especially in helicopter emergency medical systems (HEMS), which have limitations regarding loading weight and space and typically operate in rural and remote areas, whether MCDs have benefits for patients is still unknown. The aim of this study was to evaluate the use of MCDs in a large Swiss HEMS system. Materials and Methods We conducted a retrospective observational study of all HEMS missions of Swiss Air rescue Rega between January 2014 and June 2016 with the use an MCD (Autopulse®). Details of MCD use and patient outcome are reported from the medical operation journals and the hospitals’ discharge letters. Results MCDs were used in 626 HEMS missions and 590 patients (94%) could be included. 478 (81%) were primary missions and 112 (19%) were interhospital transfers. 49 of the patients in primary missions were loaded under ongoing CPR with MCDs. In the patients loaded after return of spontaneous circulation (ROSC), 20 (7%) experienced a second CA during the flight. In interhospital transfers 102 (91%) only needed standby use of the MCD. Five (4.5%) patients were loaded into the helicopter with ongoing CPR. Five (4.5%) patients went into CA during flight and the MCD had to be activated. Conclusion We conclude that equipping HEMS with MCDs may be beneficial, with non-trauma patients potentially benefitting more than trauma patients.

Evaluation of the performance of French physician-staffed emergency medical service in the triage of major trauma patients

2014 ◽  
Vol 76 (6) ◽  
pp. 1476-1483 ◽  
Author(s):  
Sophie Rym Hamada ◽  
Tobias Gauss ◽  
François-Xavier Duchateau ◽  
Jennifer Truchot ◽  
Anatole Harrois ◽  
...  
Keyword(s):  
Emergency Medical Service ◽  
Major Trauma ◽  
Medical Service ◽  
Trauma Patients ◽  
Emergency Medical ◽  
French Physician

Trauma Incidents Attended by Emergency Medical Services in Victoria, Australia

2008 ◽  
Vol 23 (1) ◽  
pp. 20-28 ◽  
Author(s):  
Malcolm J. Boyle ◽  
M ClinEpi ◽  
Erin C. Smith ◽  
Frank L. Archer
Keyword(s):  
Emergency Medical Services ◽  
Emergency Medical Service ◽  
Medical Service ◽  
Medical Services ◽  
Data Repository ◽  
Trauma Patients ◽  
Minor Trauma ◽  
Specific Level ◽  
Emergency Medical ◽  
Trauma Responses

AbstractIntroduction:International literature describing the profile of trauma patients attended by a statewide emergency medical services (EMS) system is lacking. Most literature is limited to descriptions of trauma responses for a single emergency medical service, or to patients transported to a specific Level-1 trauma hospital. There is no Victorian or Australian literature describing the type of trauma patients transported by a state emergency medical service.Purpose:The purpose of this study was to define a profile of all trauma incidents attended by statewide EMS.Methods:A retrospective cohort study of all patient care records (PCR) for trauma responses attended by Victorian Ambulance Services for 2002 was conducted. Criteria for trauma categories were defined previously, and data were extracted from the PCRs and entered into a secure data repository for descriptive analysis to determine the trauma profile. Ethics committee approval was obtained.Results:There were 53,039 trauma incidents attended by emergency ambulances during the 12-month period. Of these, 1,566 patients were in physiological distress, 11,086 had a significant pattern of injury, and a further 8,931 had an identifiable mechanism of injury. The profile includes minor trauma (n = 9,342), standing falls (n = 20,511), no patient transported (n = 3,687), and deceased patients (n = 459).Conclusions:This is a unique analysis of prehospital trauma. It provides a baseline dataset that may be utilized in future studies of prehospital trauma care. Additionally, this dataset identifies a ten-fold difference in major trauma between the prehospital and the hospital assessments.

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