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2017 ; 2
(1
): e000122
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Faster on-scene times associated with decreased mortality in Helicopter Emergency
Medical Services (HEMS) transported trauma patients
#MMPMID29766113
Pham H
; Puckett Y
; Dissanaike S
Trauma Surg Acute Care Open
2017[]; 2
(1
): e000122
PMID29766113
show ga
BACKGROUND: The 'Golden Hour' emphasizes the importance of rapidly providing
definitive care to trauma patients. Dispatch time, defined as the time it takes
the Helicopter Emergency Medical Service (HEMS) to dispatch from their base and
reach the patient, and on-scene time, defined as the time spent with the patient
prior to departure to a trauma center, can impact how quickly the patient will
reach definitive care. We evaluated HEMS dispatch and on-scene times by
investigating the survival rates among patients transported by air to a level 1
trauma center. We hypothesize that longer HEMS dispatch and on-scene times are
associated with worse patient outcomes. METHODS: A retrospective, single
institution analysis was performed on patients transported by HEMS. Inclusion
criteria were air transported patients aged 18 years and above admitted to a
level 1 trauma center from January 1, 2005 to January 1, 2015. Total dispatch
time and on-scene times were divided into five incremental groups and mortality
data were analyzed. Mortality was defined as death during initial hospital
admission. A Pearson's correlation was used to analyze relationship between
dispatch times, on-scene times, and mortality. Simple binary logistic regression
was used to run a multivariate analysis on confounding variables of Injury
Severity Score (ISS), gender, age, and Glasgow Coma Scale. RESULTS: There was a
strong positive linear correlation between HEMS on-scene time and mortality,
R=0.962, p=0.038. Additionally, there was a positive trend between HEMS dispatch
time and mortality. ISS was found to be a significant confounder of mortality in
our cohort with on-scene times >20?min, with mortality increasing by 7.5% for
every 0.1 increase in ISS score (p=0.01). CONCLUSION: Longer HEMS on-scene and
dispatch times appeared to be associated with increased mortality in trauma
patients. However, those with higher ISS require longer on-scene times,
increasing mortality. Regardless, efforts should focus on reducing on-scene and
dispatch times. LEVEL OF EVIDENCE AND STUDY TYPE: Level III; Therapeutic/Care
Management.