title: Impact of critical care-trained flight paramedics on casualty survival during helicopter evacuation in the current war in Afghanistan.
abstract: BACKGROUND
  The US Army pioneered medical evacuation (MEDEVAC) by helicopter, yet its system remains essentially unchanged since the Vietnam era. Care is provided by a single combat medic credentialed at the Emergency Medical Technician - Basic level. Treatment protocols, documentation, medical direction, and quality improvement processes are not standardized and vary significantly across US Army helicopter evacuation units. This is in contrast to helicopter emergency medical services that operate within the United States. Current civilian helicopter evacuation platforms are routinely staffed by critical care-trained flight paramedics (CCFP) or comparably trained flight nurses who operate under trained EMS physician medical direction using formalized protocols, standardized patient care documentation, and rigorous quality improvement processes. This study compares mortality of patients with injury from trauma between the US Army's standard helicopter evacuation system staffed with medics at the Emergency Medical Technician - Basic level (standard MEDEVAC) and one staffed with experienced CCFP using adopted civilian helicopter emergency medical services practices.
  
  
  METHODS
  This is a retrospective study of a natural experiment. Using data from the Joint Theater Trauma Registry, 48-hour mortality for severely injured patients (injury severity score ≥ 16) was compared between patients transported by standard MEDEVAC units and CCFP air ambulance units.
  
  
  RESULTS
  The 48-hour mortality for the CCFP-treated patients was 8% compared to 15% for the standard MEDEVAC patients. After adjustment for covariates, the CCFP system was associated with a 66% lower estimated risk of 48-hour mortality compared to the standard MEDEVAC system.
  
  
  CONCLUSIONS
  These findings demonstrate that using an air ambulance system based on modern civilian helicopter EMS practice was associated with a lower estimated risk of 48-hour mortality among severely injured patients in a combat setting.
authors: US Army Institute of Surgical Research, Fort Sam Houston, San Antonio, Texas 78234-6315, USA. robert.mabry@us.army.mil
authors: Robert L
authors: RL
authors: Mabry
authors: Amy
authors: A
authors: Apodaca
authors: Jason
authors: J
authors: Penrod
authors: Jean A
authors: JA
authors: Orman
authors: Robert T
authors: RT
authors: Gerhardt
authors: Warren C
authors: WC
authors: Dorlac
mesh_terms: D000328:Adult; D055826:Afghan Campaign 2001-; D017732:Air Ambulances / Q000706:statistics & numerical data; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D004634:Emergency Medical Technicians / Q000706:statistics & numerical data; D006801:Humans; D015601:Injury Severity Score; D008887:Military Medicine / Q000706:statistics & numerical data; D012189:Retrospective Studies; D014481:United States; D000078329:Workforce; D014947:Wounds and Injuries / Q000401:mortality* / Q000628:therapy