Effects of physician-based emergency medical service dispatch in severe traumatic brain injury on prehospital run time.
BACKGROUND
Prehospital care by physician-based helicopter emergency medical services (P-HEMS) may prolong total prehospital run time. This has raised an issue of debate about the benefits of these services in traumatic brain injury (TBI). We therefore investigated the effects of P-HEMS dispatch on prehospital run time and outcome in severe TBI.


METHODS
Prehospital run times of 497 patients with severe TBI who were solely treated by a paramedic EMS (n = 125) or an EMS/P-HEMS combination (n = 372) were retrospectively analyzed. Other study parameters included the injury severity score (ISS), Glasgow Coma Scale (GCS), prehospital endotracheal intubation and predicted and observed outcome rates.


RESULTS
Patients who received P-HEMS care were younger and had higher ISS values than solely EMS-treated patients (10%; P = 0.04). The overall prehospital run time was 74 ± 54 min, with similar out-of-hospital times for EMS and P-HEMS treated patients. Prehospital endotracheal intubation was more frequently performed in the P-HEMS group (88%) than in the EMS group (35%; P<0.001). The prehospital run time for intubated patients was similar for P-HEMS (66 (51-80)min) and EMS-treated patients (59 (41-88 min). Unexpectedly, mortality probability scores and observed outcome scores were less favourable for EMS-treated patients when compared to patients treated by P-HEMS.


CONCLUSIONS
P-HEMS dispatch does not increase prehospital run times in severe TBI, while it assures prehospital intubation of TBI patients by a well-trained physician. Our data however suggest that a subgroup of the most severely injured patients received prehospital care by an EMS, while international guidelines recommend advanced life support by a physician-based EMS in these cases.
Department of Anesthesiology, VU University Medical Center, Amsterdam, The Netherlands. g.franschman@vumc.nl
G
G
Franschman
N
N
Verburg
V
V
Brens-Heldens
T M J C
TM
Andriessen
J
J
Van der Naalt
S M
SM
Peerdeman
J P
JP
Valk
N
N
Hoogerwerf
S
S
Greuters
P
P
Schober
P E
PE
Vos
H M T
HM
Christiaans
C
C
Boer
D000328:Adult; D017732:Air Ambulances; D001930:Brain Injuries / Q000150:complications / Q000453:epidemiology / Q000628:therapy*; D004632:Emergency Medical Services / Q000458:organization & administration; D005260:Female; D015600:Glasgow Coma Scale; D019983:Guideline Adherence; D006801:Humans; D015601:Injury Severity Score; D007442:Intubation, Intratracheal / Q000379:methods*; D008297:Male; D017063:Outcome Assessment, Health Care; D010820:Physicians; D017410:Practice Guidelines as Topic; D011379:Prognosis; D012189:Retrospective Studies; D013997:Time Factors; D000078329:Workforce