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Edited by Jonathan Wyatt; this scan coordinated by Jason Lee
Benefits of helicopter emergency medical systems ▸
Few areas of emergency care polarise opinion more than the benefit of Helicopter Emergency Medical Systems (HEMS). This is partly due to conflicting reports in the literature and difficulties in direct comparison of systems which vary according to region and country. This latest report is a prospective, observational study from a group in the Netherlands, whose operating system is similar to the London HEMS. Between 2000 and 2002, 346 patients with an injury severity score greater than 15 presented to a Rotterdam trauma centre. Trauma patients who were attended by helicopter-trained medical teams had increased odds of survival compared with those who were attended by ambulance staff alone. Although the evidence of benefit did not quite reach the levels of 95% confidence it will lend some weight to supporters of HEMS. Operational costs, however, were not considered.
Increased mortality with prehospital intubation ▸
This study is the largest of its type to date and echoes the findings of three recent studies which found that prehospital intubation for brain injury was associated with a worse outcome. Retrospective data (2000–2002) on 4098 patients with head/neck abbreviated injury scores (AIS) of 3 or more who had been intubated in either a hospital or a prehospital setting were collected from a register of all patients presenting to recognised trauma centres in Pennsylvania. Transfers were excluded. The primary outcome was death, and the secondary outcomes were neurological and functional outcomes. Multivariate logistic regression was used to adjust for variables such as age, AIS, injury severity score, blood pressure, mechanism of injury, and mode of transport. The adjusted odds of death for patients intubated prehospital was four times that of patients intubated in the emergency department. Patients intubated prehospital also had increased odds of poor neurological and functional outcomes. An interesting subset …