Prehospital advanced life support provided by specially trained physicians: is there a benefit in terms of life years gained?
BACKGROUND
The benefit of prehospital advanced life support (ALS) is disputed, as is the prehospital use of specially trained, hospital-based physicians. The purpose of the study was to assess the health benefit from an anesthesiologist-manned prehospital emergency medical service (EMS), and to separate the benefit of the anesthesiologist from that of rapid transport.


METHODS
The anesthesiologist-manned helicopter and rapid response car service at Rogaland Central Hospital assisted 1106 patients at the scene during the 18-month study period. Two expert panels assessed patients with a potential health benefit for life years gained (LYG) using a modified Delphi technique. The probability of survival as a result of the studied EMS was multiplied by the life expectancy of each patient. The benefit was attributed either to the anesthesiologist, the rapid transport or a combination of both.


RESULTS
The expert panels estimated a benefit of 504 LYG in 74 patients (7% of the total study population), with a median age of 54 years (range 0-88). The cause of the emergency was cardiac diseases (including cardiac arrest) in 61% of the 74 patients, trauma in 19%, and cardio-respiratory failure as a result of other conditions in 20%. The LYG were equally divided between air and ground missions, and the majority (88%) were attributed solely to ALS by the anesthesiologist.


CONCLUSIONS
The expert panels found LYG in every 14th patient assisted by this anesthesiologist-manned prehospital EMS. There was no difference in LYG between the helicopter and the rapid response car missions. The role of the anesthesiologist was crucial for health benefits.
Lossius
H M
HM
Department of Anesthesia and Intensive Care, Rogaland Central Hospital, Stavanger, Norwegian Air Ambulance, Oslo, Norway. hamolo@online.no
Søreide
E
E
Hotvedt
R
R
Hapnes
S A
SA
Eielsen
O V
OV
Førde
O H
OH
Steen
P A
PA
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000776:Anesthesiology; D002648:Child; D002675:Child, Preschool; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D006323:Heart Arrest / Q000401:mortality / Q000628:therapy; D006331:Heart Diseases / Q000401:mortality / Q000628:therapy; D006801:Humans; D007223:Infant; D008020:Life Support Care; D008297:Male; D008875:Middle Aged; D019057:Quality-Adjusted Life Years; D012131:Respiratory Insufficiency / Q000401:mortality / Q000628:therapy; D015996:Survival Rate; D014947:Wounds and Injuries / Q000401:mortality / Q000628:therapy