title: [Extended medical quality management exemplified by the tracer diagnosis multiple trauma. Pilot study in the air rescue service].
abstract: BACKGROUND
  Adequate prehospital and inhospital primary care is a decisive factor in the successful treatment of multiple trauma patients. For optimization of treatment algorithms the implementation of a medical quality management is of utmost importance. The aim of this study was to extend quality management by including data on process quality.
  
  
  METHODS
  A retrospective study of primary rescue missions of the Helicopter Emergency Medical Service (HEMS) Christoph 22 in Ulm over a period of 2.5 years was performed. In a detailed analysis of filter criteria, in which relevant deviations from the recommendations (not fulfilled in  > 10% of the cases) occurred, process data was included (vital data, measurements and events).
  
  
  RESULTS
  In the study population (n = 298, males 71.8%, mean age 39.8 ± 21.8 years) 2 filter criteria were identified in which relevant deviations where observed: time management where prehospital treatment time  ≤ 60 min in 36% of the cases was not fulfilled and circulatory management where the systolic blood pressure, detected with Riva-Rocci method (RR(sys))  ≥ 120 mmHg on hospital admission in patients with severe head trauma was not fulfilled in 45% of the cases. In patients with deviations in time management, prehospital treatment time was prolonged (75.6 ± 18.3 min versus 50.5 ± 6.7 min; p < 0.01) caused by a prolonged on scene attendance time (34.1 ± 22.1 min versus 20.6 ± 9.2 min; p < 0.01) and transport time (17.3 ± 9.4 min versus 13.3 ± 4.8 min; p < 0.01). In entrapment trauma prehospital treatment time was expanded (44% versus 10%; p < 0.01). Patients in whom circulatory management deviations were observed were more often in shock on arrival at the scene (RR(sys)  ≤ 90 mmHg: 60% versus 30%; p < 0.01), more often hypoxemic [pulse oximeter oxygen saturation (S(p)O(2)) ≤ 90%: 36% versus 19%; p < 0.05] and more often sustained a trauma to the chest as well as to chest and abdomen/pelvis (69% versus 52% and 42% versus 28%, respectively; p < 0.05). Furthermore, the infusion volume of colloids was higher (1241 ± 810 ml versus 753 ± 359 ml; p < 0.05) and the combined usage of small volume resuscitation and catecholamines was more often necessary (42% versus 25%; p < 0.05).
  
  
  CONCLUSIONS
  Including process data of prehospital mission data recording facilitates an extended medical quality management.
authors.affiliation: Abteilung für Anästhesiologie und Intensivmedizin/Sektion Notfallmedizin, Bundeswehrkrankenhaus Ulm, Deutschland. matthias.helm@extern.uni-ulm.de
authors.forename: M
authors.initials: M
authors.lastname: Helm
authors.forename: J
authors.initials: J
authors.lastname: Hauke
authors.forename: O
authors.initials: O
authors.lastname: Schlafer
authors.forename: T
authors.initials: T
authors.lastname: Schlechtriemen
authors.forename: L
authors.initials: L
authors.lastname: Lampl
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017732:Air Ambulances; D000465:Algorithms; D001794:Blood Pressure / Q000502:physiology; D001802:Blood Substitutes / Q000008:administration & dosage / Q000627:therapeutic use; D016887:Cardiopulmonary Resuscitation; D002395:Catecholamines / Q000627:therapeutic use; D003102:Colloids / Q000008:administration & dosage / Q000627:therapeutic use; D006259:Craniocerebral Trauma / Q000453:epidemiology / Q000628:therapy; D004632:Emergency Medical Services / Q000379:methods*; D005260:Female; D006801:Humans; D000860:Hypoxia / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000175:diagnosis*; D010865:Pilot Projects; D011787:Quality of Health Care; D018635:Rescue Work; D012189:Retrospective Studies; D013898:Thoracic Injuries / Q000628:therapy; D055815:Young Adult
chemical_list: D001802:Blood Substitutes; D002395:Catecholamines; D003102:Colloids