Variation in Air Medical Outcomes by Crew Composition: A Two-Year Follow-Up,☆☆,

Presented at the Society for Academic Emergency Medicine Annual Meeting, Washington, DC, May 1994.
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Abstract

Study objective: In a previous 1-year retrospective study, we found no differences in outcomes of patients transported by physician/nurse (P/N) and nurse/nurse (N/N) air medical crews. To confirm this finding and to identify any trends in outcome that might be associated with changes in crew composition, we prospectively collected and analyzed 2 additional years of severity and outcome data.

Design: Prospective cohort. Setting: University hospital-based air medical program. Results: Severity measured by APACHE-II, the Revised Trauma Score, and the Therapeutic Intervention Scoring System, and outcomes measured by mortality and the number of ICU and hospital days, were gathered prospectively on all adult air medical patients between July 1, 1990, and June 30, 1992. Patients less than 16 years old or those who were delivered to other hospitals were excluded. Patients were categorized as cardiac, acute trauma, and other. Origin of transfer and transfer times were included in the analysis. In all, 1,169 patients were studied—554 in the first year of the study, 615 in the second. In the first year, there were 185 P/N (33%) and 369 N/N (67%) flights. P/N patients were older (48.8 versus 44.5 years; P =.01) and were more likely to come from a scene (14% versus 5.7%; P =.001), but no differences were found with regard to sex or disease category. Mortality, the Therapeutic Intervention Scoring System, APACHE-II, number of ICU days, and number of hospital days were not different; nor were total flight times or times spent at the hospital or scene. In the second year, 89% of flights were N/N. Differences in age or origin were not observed. Severity levels and outcomes remained unchanged. Between 1987 and 1992, the proportion of cardiac patients decreased, and overall illness severity of transported patients increased. Conclusion: Two years of detailed prospective measurement of air medical patient characteristics and outcomes confirmed the initial finding that no significant differences in clinical outcomes could be identified between patients managed by P/N versus N/N crews. [Burney RE, Hubert D, Passini L, Maio R: Variation in air medical outcomes by crew composition: A two-year follow-up. Ann Emerg Med February 1995;25:187-192.]

Section snippets

INTRODUCTION

Across the United States, the majority of air medical crews are composed of nurses and paramedics who work under physician supervision. Only 10% or fewer of air medical services use physicians as regular crew members on board aircraft.1 Nevertheless, in some areas of the country, flight programs advertise the advantages of a physician-based crew, and the question remains unsettled. Early studies addressing this question, using posttransport survey data and questions focused on "need" for

MATERIALS AND METHODS

Data were collected prospectively by flight nurses on all adult patients transported to University of Michigan Hospitals by Survival Flight between July 1, 1990, and June 30, 1992. During this period, the service used two identical aircraft, one in operation 24 hours a day and one in operation 12 hours a day. When two aircraft were flying, flights were taken by either the P/N team or the N/N team on a first-team-available basis. At other times, the N/N crew responded to all requests. Patients

RESULTS

During the 2-year study period, 2,073 air medical transfers were completed; 1,768 (85%) returned to University of Michigan Hospitals. After exclusion of neonatal transfers and patients less than 16 years old, 1,170 patients remainedfor analysis. Complete outcome data were obtained on 1,169 of these, 554 in the first year and 615 in the second. Two hundred fifty-five patients (22%) were transferred by a P/N team, 914 (78%) by a N/N team. Six hundred eighty-seven transfers (58%) originated from

DISCUSSION

Detailed study of patient and flight characteristics, illness and injury severity, and results of treatment over a 4-year period, during which the transition from all P/N flight teams to almost all N/N flight teams was made, demonstrated that the composition of the flight team had no measurable effect on flight response, patient care during transfer, or eventual hospital outcome.

Both this and the previous study were descriptive. Nevertheless, by providing longitudinal information on both

CONCLUSION

Two years of prospective measurement of patient severity of illness or injury and hospital outcomes confirmed the findings of an earlier study that there are no differences in outcomes of unselected adult patients transported by P/N and N/N air medical crews. There is no objective evidence to support the contention that one type of flight crew is superior or preferable to another.

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From the Section of Emergency Medicine, Department of Surgery, University of Michigan, Ann Arbor.

☆☆

Address for reprints: Richard E Burney, MD, TC 2922 University Hospital, 1500 East Medical Center Drive, Ann Arbor, Michigan 48109-0331, 313-936-6025, Fax 313-936-5830

Reprint no. 47/1/61924

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