Study: Chopper trauma transport improves survival chances

[SRS131EMTFF 471]

Study: Chopper trauma transport improves survival chances

http://thechart.blogs.cnn.com/2012/04/17/study-chopper-trauma-transport-improves-survival-chances/?hpt=hp_bn12

While the percentage was small, 1.4 percent to 1.5 percent depending on the trauma level, in every 65-69 severely injured patients taken to a level I or II trauma hospital, one life was saved.

[mvfire8989 22]

I just had a chance to read the original article in JAMA, while the authors did conclude that there was a 1.5% better chance of survival they were not able to control for many of the factors affecting mortality. This figure comes from comparing two groups that were statistically matched by values recorded on arrival to the ED. Due to a high amount of missing data about transport times "that cannot be assumed to be missing at random" the study was not able to make judgments about how the total time from dispatch to the ED played a role.

[Bull McCaffrey 162]

Does anyone here know what the criteria is in deciding whether or not to call Stat Flight to the scene of a job? I know there were certain qualifying factors such as a fall from over a certain height or "X" amount of intrusion into a vehicle as a result of an MVA. There were some other qualifying factors but I forget what they are. If someone knows can you please post them?

[mvfire8989 22]

Does anyone here know what the criteria is in deciding whether or not to call Stat Flight to the scene of a job? I know there were certain qualifying factors such as a fall from over a certain height or "X" amount of intrusion into a vehicle as a result of an MVA. There were some other qualifying factors but I forget what they are. If someone knows can you please post them?

Here it is:

http://www.health.ny.gov/nysdoh/ems/policy/05-05.htm

[Bull McCaffrey 162]

Thank you.

[Goose 188]

Does anyone here know what the criteria is in deciding whether or not to call Stat Flight to the scene of a job? I know there were certain qualifying factors such as a fall from over a certain height or "X" amount of intrusion into a vehicle as a result of an MVA. There were some other qualifying factors but I forget what they are. If someone knows can you please post them?

I think you're talking about trauma center criteria when you reference falling from 2 - 3 times a patient's height or impact dynamics of a MVA. In terms of utilizing the chopper specifically in this area, take a look at this link

http://www.wremsco.o...nes (v2011).pdf

As for the study, too much is open to interpretation. Personally, i feel the efficacy for a helicopter transport in Westchester is limited.

Edited April 19, 2012 by Goose

[mvfire8989 22]

I think you're talking about trauma center criteria when you reference falling from 2 - 3 times a patient's height or impact dynamics of a MVA. In terms of utilizing the chopper specifically in this area, take a look at this link

http://www.wremsco.o...nes (v2011).pdf

As for the study, too much is open to interpretation. Personally, i feel the efficacy for a helicopter transport in Westchester is limited.

Could you clarify what you mean by "too much is open to interpretation?" If nothing else, it is interesting that when variables such as severity of the trauma, vitals and others were controlled for nationwide any patient who goes by helicopter is better off.

[Goose 188]

Could you clarify what you mean by "too much is open to interpretation?" If nothing else, it is interesting that when variables such as severity of the trauma, vitals and others were controlled for nationwide any patient who goes by helicopter is better off.

The abstract doesn't leave much to look at. How many traumatic arrests were included in this study (which would automatically exclude the patient from air transport) that happened to be transported to a level I or II center (the survival rate is fractional, at best, for these patients)? Is 1.4 v 1.5 statistically significant in terms of changing protocol/operating guidelines?

They mention two high profile cases in the link the OP provided, but i'm not sure if either apply. If Rep. Giffords was 12 minutes from a regional trauma facility the day she was shot, why would air transport even be considered? As far as Ms. Richardson, my understanding is that if she went by ambulance initially she may have survived, by the time she became unresponsive (later that day) she likely already had a midline shift or already began herniating - i'm not sure there would have been a more positive outcome given the most optimal conditions.

I suppose my concern is that people will see this and use it to justify the "when in doubt, fly em' out" mentality. Thats just not what the helicopter is for. I would argue that for the vast majority of trauma patients, in Westchester, can be received by a level 1 or 2 facility within a clinically appropriate time frame by ground ambulance.

Edited April 19, 2012 by Goose

[mvfire8989 22]

The abstract doesn't leave much to look at. How many traumatic arrests were included in this study (which would automatically exclude the patient from air transport) that happened to be transported to a level I or II center (the survival rate is fractional, at best, for these patients)? Is 1.4 v 1.5 statistically significant in terms of changing protocol/operating guidelines?

They mention two high profile cases in the link the OP provided, but i'm not sure if either apply. If Rep. Giffords was 12 minutes from a regional trauma facility the day she was shot, why would air transport even be considered? As far as Ms. Richardson, my understanding is that if she went by ambulance initially she may have survived, by the time she became unresponsive (later that day) she likely already had a midline shift or already began herniating - i'm not sure there would have been a more positive outcome given the most optimal conditions.

I suppose my concern is that people will see this and use it to justify the "when in doubt, fly em' out" mentality. Thats just not what the helicopter is for. I would argue that for the vast majority of trauma patients, in Westchester, can be received by a level 1 or 2 facility within a clinically appropriate time frame by ground ambulance.

Thanks for getting back to me Goose,

The study should have somewhat controlled for that since vitals were matched statistically between the groups. They used 161566 ground transports and 61909 flights to come up with the number.