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.
Department of Anesthesia and Intensive Care, Rogaland Central Hospital, Stavanger, Norwegian Air Ambulance, Oslo, Norway. hamolo@online.no
H M
HM
Lossius
E
E
Søreide
R
R
Hotvedt
S A
SA
Hapnes
O V
OV
Eielsen
O H
OH
Førde
P A
PA
Steen
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