HEMS vs. Ground-BLS care in traumatic cardiac arrest.
OBJECTIVE
To assess whether a top-level type of prehospital care, made of helicopter, physician, and advanced life support (ALS) procedures, improves the outcome of blunt trauma victims found in cardiac arrest (CA) as compared with a simpler type, composed of ground ambulance, nurse, and expanded basic life support (BLS).


METHODS
This was a cohort study from the data set of a prospective, population-based, 12-month study targeting the 1,200,000 inhabitants of the Italian region Friuli Venezia Giulia.


RESULTS
Fifty-six victims received the higher level of care (helicopter emergency medical services [HEMS] group) and 73 received the lower one (ground-BLS group). The two groups were homogeneous for mechanism of injury, gender, and time interval before cardiopulmonary resuscitation (CPR). Age was lower in the ground-BLS group. The percentage of patients in which CPR was attempted was significantly higher in the HEMS group (43% vs. 20%; CI 0.061 to 0.379). On-scene return of spontaneous circulation (ROSC) was also more likely in the HEMS group (37.5% of attempted CPRs vs. 6.6%; CI 0.027 to 0.591). None of the patients evacuated from the scene without ROSC ever attained it in hospital. This policy was virtually exclusive to the ground-BLS group. Survival to hospital discharge was 3.5% (severely disabled) in the HEMS group and 0% in the ground-BLS group (CI -0.008 to 0.078).


CONCLUSIONS
A top-level type of prehospital care had significantly more chances to resuscitate blunt trauma victims found in CA as compared with a simpler level. No significant benefit on long-term outcome was found, but more cases might be needed in future studies because of the inevitably low number of survivors.
Di Bartolomeo
Stefano
S
Italian Resuscitation Council, Trauma Committee, Italy. dibartolomeo.stefano@aoud.sanita.fvg.it
Sanson
Gianfranco
G
Nardi
Giuseppe
G
Michelutto
Vanni
V
Scian
Franca
F
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017732:Air Ambulances; D000552:Ambulances; D016887:Cardiopulmonary Resuscitation / Q000379:methods* / Q000401:mortality; D015331:Cohort Studies; D016001:Confidence Intervals; D004632:Emergency Medical Services / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006323:Heart Arrest / Q000209:etiology / Q000401:mortality* / Q000628:therapy*; D006801:Humans; D007558:Italy; D008020:Life Support Care / Q000379:methods; D008297:Male; D008875:Middle Aged; D011336:Probability; D011446:Prospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000150:complications