Physician-staffed helicopter emergency medical service has a beneficial impact on the incidence of prehospital hypoxia and secured airways on patients with severe traumatic brain injury
Abstract Background After traumatic brain injury (TBI), hypotension, hypoxia and hypercapnia have been shown to result in secondary brain injury that can lead to increased mortality and disability. Effective prehospital assessment and treatment by emergency medical service (EMS) is considered essent...
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| Format: | Article |
| Language: | English |
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BMC
2017-09-01
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| Series: | Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s13049-017-0438-1 |
| _version_ | 1819132499073171456 |
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| author | Toni Pakkanen Antti Kämäräinen Heini Huhtala Tom Silfvast Jouni Nurmi Ilkka Virkkunen Arvi Yli-Hankala |
| author_facet | Toni Pakkanen Antti Kämäräinen Heini Huhtala Tom Silfvast Jouni Nurmi Ilkka Virkkunen Arvi Yli-Hankala |
| author_sort | Toni Pakkanen |
| collection | DOAJ |
| description | Abstract Background After traumatic brain injury (TBI), hypotension, hypoxia and hypercapnia have been shown to result in secondary brain injury that can lead to increased mortality and disability. Effective prehospital assessment and treatment by emergency medical service (EMS) is considered essential for favourable outcome. The aim of this study was to evaluate the effect of a physician-staffed helicopter emergency medical service (HEMS) in the treatment of TBI patients. Methods This was a retrospective cohort study. Prehospital data from two periods were collected: before (EMS group) and after (HEMS group) the implementation of a physician-staffed HEMS. Unconscious prehospital patients due to severe TBI were included in the study. Unconsciousness was defined as a Glasgow coma scale (GCS) score ≤ 8 and was documented either on-scene, during transportation or by an on-call neurosurgeon on hospital admission. Modified Glasgow Outcome Score (GOS) was used for assessment of six-month neurological outcome and good neurological outcome was defined as GOS 4–5. Results Data from 181 patients in the EMS group and 85 patients in the HEMS group were available for neurological outcome analyses. The baseline characteristics and the first recorded vital signs of the two cohorts were similar. Good neurological outcome was more frequent in the HEMS group; 42% of the HEMS managed patients and 28% (p = 0.022) of the EMS managed patients had a good neurological recovery. The airway was more frequently secured in the HEMS group (p < 0.001). On arrival at the emergency department, the patients in the HEMS group were less often hypoxic (p = 0.024). In univariate analysis HEMS period, lower age and secured airway were associated with good neurological outcome. Conclusion The introduction of a physician-staffed HEMS unit resulted in decreased incidence of prehospital hypoxia and increased the number of secured airways. This may have contributed to the observed improved neurological outcome during the HEMS period. Trial registration ClinicalTrials.gov IDNCT02659046. Registered January 15th, 2016. |
| first_indexed | 2024-12-22T09:32:22Z |
| format | Article |
| id | doaj.art-31fdfc365eb545e788054b47f8a5baaa |
| institution | Directory Open Access Journal |
| issn | 1757-7241 |
| language | English |
| last_indexed | 2024-12-22T09:32:22Z |
| publishDate | 2017-09-01 |
| publisher | BMC |
| record_format | Article |
| series | Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine |
| spelling | doaj.art-31fdfc365eb545e788054b47f8a5baaa2022-12-21T18:30:54ZengBMCScandinavian Journal of Trauma, Resuscitation and Emergency Medicine1757-72412017-09-012511710.1186/s13049-017-0438-1Physician-staffed helicopter emergency medical service has a beneficial impact on the incidence of prehospital hypoxia and secured airways on patients with severe traumatic brain injuryToni Pakkanen0Antti Kämäräinen1Heini Huhtala2Tom Silfvast3Jouni Nurmi4Ilkka Virkkunen5Arvi Yli-Hankala6FinnHEMS Ltd, Research and Development UnitTays Emergency Medical Service, FinnHEMS 30, Tampere University HospitalFaculty of Social Sciences, University of TampereDepartment of Anaesthesia and Intensive Care, Helsinki University Hospital, University of HelsinkiDepartment of Emergency Medicine and Services, Helsinki University Hospital and Emergency Medicine, University of HelsinkiFinnHEMS Ltd, Research and Development UnitDepartment of Anaesthesia, Tampere University HospitalAbstract Background After traumatic brain injury (TBI), hypotension, hypoxia and hypercapnia have been shown to result in secondary brain injury that can lead to increased mortality and disability. Effective prehospital assessment and treatment by emergency medical service (EMS) is considered essential for favourable outcome. The aim of this study was to evaluate the effect of a physician-staffed helicopter emergency medical service (HEMS) in the treatment of TBI patients. Methods This was a retrospective cohort study. Prehospital data from two periods were collected: before (EMS group) and after (HEMS group) the implementation of a physician-staffed HEMS. Unconscious prehospital patients due to severe TBI were included in the study. Unconsciousness was defined as a Glasgow coma scale (GCS) score ≤ 8 and was documented either on-scene, during transportation or by an on-call neurosurgeon on hospital admission. Modified Glasgow Outcome Score (GOS) was used for assessment of six-month neurological outcome and good neurological outcome was defined as GOS 4–5. Results Data from 181 patients in the EMS group and 85 patients in the HEMS group were available for neurological outcome analyses. The baseline characteristics and the first recorded vital signs of the two cohorts were similar. Good neurological outcome was more frequent in the HEMS group; 42% of the HEMS managed patients and 28% (p = 0.022) of the EMS managed patients had a good neurological recovery. The airway was more frequently secured in the HEMS group (p < 0.001). On arrival at the emergency department, the patients in the HEMS group were less often hypoxic (p = 0.024). In univariate analysis HEMS period, lower age and secured airway were associated with good neurological outcome. Conclusion The introduction of a physician-staffed HEMS unit resulted in decreased incidence of prehospital hypoxia and increased the number of secured airways. This may have contributed to the observed improved neurological outcome during the HEMS period. Trial registration ClinicalTrials.gov IDNCT02659046. Registered January 15th, 2016.http://link.springer.com/article/10.1186/s13049-017-0438-1Prehospital emergency care (MeSH)Emergency medical services (MeSH)Critical care (MeSH)Traumatic brain injury (MeSH)Airway management (MeSH)Endotracheal intubation (MeSH) |
| spellingShingle | Toni Pakkanen Antti Kämäräinen Heini Huhtala Tom Silfvast Jouni Nurmi Ilkka Virkkunen Arvi Yli-Hankala Physician-staffed helicopter emergency medical service has a beneficial impact on the incidence of prehospital hypoxia and secured airways on patients with severe traumatic brain injury Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine Prehospital emergency care (MeSH) Emergency medical services (MeSH) Critical care (MeSH) Traumatic brain injury (MeSH) Airway management (MeSH) Endotracheal intubation (MeSH) |
| title | Physician-staffed helicopter emergency medical service has a beneficial impact on the incidence of prehospital hypoxia and secured airways on patients with severe traumatic brain injury |
| title_full | Physician-staffed helicopter emergency medical service has a beneficial impact on the incidence of prehospital hypoxia and secured airways on patients with severe traumatic brain injury |
| title_fullStr | Physician-staffed helicopter emergency medical service has a beneficial impact on the incidence of prehospital hypoxia and secured airways on patients with severe traumatic brain injury |
| title_full_unstemmed | Physician-staffed helicopter emergency medical service has a beneficial impact on the incidence of prehospital hypoxia and secured airways on patients with severe traumatic brain injury |
| title_short | Physician-staffed helicopter emergency medical service has a beneficial impact on the incidence of prehospital hypoxia and secured airways on patients with severe traumatic brain injury |
| title_sort | physician staffed helicopter emergency medical service has a beneficial impact on the incidence of prehospital hypoxia and secured airways on patients with severe traumatic brain injury |
| topic | Prehospital emergency care (MeSH) Emergency medical services (MeSH) Critical care (MeSH) Traumatic brain injury (MeSH) Airway management (MeSH) Endotracheal intubation (MeSH) |
| url | http://link.springer.com/article/10.1186/s13049-017-0438-1 |
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