title: Addition of physicians to paramedic helicopter services decreases blunt trauma mortality.
abstract: BACKGROUND
  The authors hypothesized that the addition of critical care physicians to the flight crew of paramedic helicopter services would decrease mortality in blunt trauma, and that this would be due to the greater procedural capability and clinical judgement of the physician.
  
  
  METHODS
  Retrospective comparison was undertaken of patients flown directly from the accident scene over a 28-month period by the paramedic-staffed Westpac Hunter region helicopter to John Hunter Hospital, and the physician-staffed NRMA CareFlight helicopter to Westmead or Nepean Hospitals. Inclusion criteria were blunt trauma and an Injury Severity Score of > 10. Mortality was compared by trauma score-injury severity score (TRISS) methodology.
  
  
  RESULTS
  There were 140 patients in the paramedic treatment group and 67 in the physician group. There were no significant differences between the groups in age, mechanism of injury, distance transported, response, scene or transport times. Physicians intubated a greater proportion of patients (51 vs 10%; P < 0.001) including all patients with a Glasgow Coma Score of < 9. Physicians gave significantly greater volumes of fluids to hypotensive patients (median: 5035 vs 1475 mL: P < 0.001) and performed thoracic decompressions on a larger proportion of patients (12 vs 1%; P < 0.01). The Z statistic for the physician treatment group was 2.72 (P < 0.01 ) compared with -1.16 (P = 0.25) in the paramedic group. The adjusted W statistic was 13.44 (95% CI: 7.80-19.08) suggesting that there would be between eight and 19 extra survivors per 100 patients treated in the physician group compared with the paramedic group.
  
  
  CONCLUSIONS
  Physicians perform a greater number of procedures at accident scenes without increasing scene time. This results in significantly lower mortality. Critical care physicians should be added to paramedic helicopter services for scene response to blunt trauma.
authors.affiliation: NRMA CareFlight/NSW Medical Retrieval Service, Westmead, Australia. alangarner@bigpond.com
authors.forename: A
authors.initials: A
authors.lastname: Garner
authors.forename: S
authors.initials: S
authors.lastname: Rashford
authors.forename: A
authors.initials: A
authors.lastname: Lee
authors.forename: R
authors.initials: R
authors.lastname: Bartolacci
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017732:Air Ambulances; D002648:Child; D002675:Child, Preschool; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D004634:Emergency Medical Technicians; D005440:Fluid Therapy / Q000706:statistics & numerical data; D015600:Glasgow Coma Scale; D006801:Humans; D007022:Hypotension / Q000628:therapy; D015601:Injury Severity Score; D007442:Intubation, Intratracheal / Q000706:statistics & numerical data; D008875:Middle Aged; D009517:New South Wales; D010820:Physicians; D012189:Retrospective Studies; D015996:Survival Rate; D013908:Thoracotomy / Q000706:statistics & numerical data; D013997:Time Factors; D000078329:Workforce; D014949:Wounds, Nonpenetrating / Q000401:mortality* / Q000628:therapy