Experience of pre-hospital treatment of survivors of falls-related trauma by an Australian helicopter emergency medical service.
BACKGROUND
Greater Sydney Area Helicopter Emergency Medical Service (GSA-HEMS) operates a doctor and paramedic team providing pre-hospital and inter-hospital retrieval. Falls are an important cause of morbidity and mortality among trauma patients. In NSW, patients injured by falling comprise 38% of those with serious to critical injuries (ISS>15). The mortality of falls in this group is 15.2%, higher than the mortality rate for other common injury mechanisms. Mortality rate for high falls (>5m) is similar to that of low/medium falls.


OBJECTIVE
The primary aim was describe the basic demographics, transportation, injured areas, treatment and mortality of falls survivors attended to by GSA-HEMS. The secondary aim was to determine if there was any association between height of fall, revised trauma score (RTSc) and need for advanced pre-hospital interventions.


METHODS
Cases of trauma due to falling were identified by searching an electronic database covering the period June 2007 to March 2010. Hardcopy casesheets were abstracted using a proforma. Data was collected on demographics, timings, winch use, height of fall, physiologic variables, injured areas, advanced pre-hospital interventions and mortality at 24h. Associations between height of fall and RTSc, and height of fall and pre-hospital interventions were compared using Fischer's exact test.


RESULTS
One hundred and fifty-four of 208 potential cases identified were cases of trauma due to falls, representing 13% of all pre-hospital trauma cases retrieved by the service. Median age of patients was 37, 67% of patients were male. Helicopter transport was use for 97% of cases, with 47% requiring winch extraction. High falls (>5m), which accounted for 25% of cases, were more likely to show non-normal RTSc. A greater proportion of high falls required advanced pre-hospital interventions.


CONCLUSIONS
Our experience describes a HEMS system that is often called to falls not just based on injury severity or requirement for advanced pre-hospital intervention, but also due to geographical and topographical impediments to access and transport of the patient by ground. This may have implications in forward planning and activation of HEMS services.
Greater Sydney Area Helicopter Emergency Medical Service (GSA-HEMS), Drover Rd, Bankstown Airport 2200, NSW, Australia. domjanssen@hotmail.com
D J
DJ
Janssen
B J
BJ
Burns
D000058:Accidental Falls / Q000401:mortality* / Q000706:statistics & numerical data; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017732:Air Ambulances; D000401:Aircraft; D002648:Child; D002675:Child, Preschool; D004631:Emergency Medical Service Communication Systems / Q000706:statistics & numerical data*; D004635:Emergency Medicine / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009517:New South Wales / Q000453:epidemiology; D017741:Survivors / Q000706:statistics & numerical data*; D013997:Time Factors; D015599:Trauma Severity Indices; D014947:Wounds and Injuries / Q000401:mortality* / Q000628:therapy