title: Physician staffed helicopter emergency medical service dispatch via centralised control or directly by crew - case identification rates and effect on the Sydney paediatric trauma system.
abstract: BACKGROUND
  Severe paediatric trauma patients benefit from direct transport to dedicated Paediatric Trauma Centres (PTC). Parallel case identification systems utilising paramedics from a centralised dispatch centre versus the crew of a physician staffed Helicopter Emergency Medical Service (HEMS) allowed comparison of the two systems for case identification rates and subsequent timeliness of direct transfer to a PTC.
  
  
  METHODS
  Paediatric trauma patients over a two year period from the Sydney region with an Injury Severity Score (ISS) > 15 were retrospectively identified from a state wide trauma registry. Overall paediatric trauma system performance was assessed by comparisons of the availability of the physician staffed HEMS for patient characteristics, transport mode (direct versus indirect) and the times required for the patient to arrive at the paediatric trauma centre. The proportion of patients transported directly to a PTC was compared between the times that the HEMS service was available versus the time that it was unavailable to determine if the HEMS system altered the rate of direct transport to a PTC. Analysis of variance was used to compare the identifying systems for various patient characteristics when the HEMS was available.
  
  
  RESULTS
  Ninety nine cases met the inclusion criteria, 44 when the HEMS system was operational. Patients identified for physician response by the HEMS system were significantly different to those that were not identified with higher median ISS (25 vs 18, p = 0.011), and shorter times to PTC (67 vs 261mins, p = 0.015) and length of intensive care unit stays (2 vs 0 days, p = 0.045). Of the 44 cases, 21 were not identified, 3 were identified by the paramedic system and 20 were identified by the HEMS system, (P < 0.001). Direct transport to a PTC was more likely to occur when the HEMS dispatch system was available (RR 1.81, 95% CI 1.20-2.73). The median time (minutes) to arrival at the PTC was shorter when HEMS available (HEMS available 92, IQR 50-261 versus HEMS unavailable 296, IQR 84-583, P < 0.01).
  
  
  CONCLUSIONS
  Physician staffed HEMS crew dispatch is significantly more likely to identify cases of severe paediatric trauma and is associated with a greater proportion of transports directly to a PTC and with faster times to arrival.
authors.affiliation: CareFlight, PO Box 159, Barden St, Northmead, NSW 2145, Australia. alang@careflight.org
authors.forename: Alan A
authors.initials: AA
authors.lastname: Garner
authors.forename: Anna
authors.initials: A
authors.lastname: Lee
authors.forename: Andrew
authors.initials: A
authors.lastname: Weatherall
mesh_terms: D000293:Adolescent; D017732:Air Ambulances / Q000458:organization & administration; D002648:Child; D002675:Child, Preschool; D016001:Confidence Intervals; D004631:Emergency Medical Service Communication Systems; D004635:Emergency Medicine; D004636:Emergency Service, Hospital; D006801:Humans; D007223:Infant; D009517:New South Wales; D012042:Registries; D012189:Retrospective Studies; D015599:Trauma Severity Indices; D014218:Triage; D000078329:Workforce; D014947:Wounds and Injuries / Q000145:classification / Q000175:diagnosis*