title: Physician-provided prehospital critical care, effect on patient physiology dynamics and on-scene time.
abstract: BACKGROUND
  Improved physiologic status can be seen as a surrogate measure of improved outcome and a field-friendly prognostic model such as the Mainz Emergency Evaluation Score (MEES) could quantify the effect on physiological response. We aim to examine the dynamic physiological profile as measured by this score on patients managed by physician-manned helicopter emergency medical services and how this profile was related to on-scene time expenditure and critical care interventions.
  
  
  METHODS
  Data including patient characteristics, physiological data, and description of diagnostic and therapeutic interventions were prospectively collected over two 14-day periods, summer and winter, at six participating Norwegian bases. The MEES score was utilized to examine the difference between a score measured at first patient contact (MEES 1) and end-of-care (MEES 2), (MEES 2-MEES 1=[INCREMENT]MEES).
  
  
  RESULTS
  A total of 240 primary missions with patient-on-scene form the basis of the study. In total, 43% were considered severely ill or injured, of whom 59% were medical patients. Twenty-nine percent were severely deranged physiologically. The most common advanced procedure performed was advanced airway management (15%), followed by defibrillation (8.8%). Using [INCREMENT]MEES as an indicator, 1% deteriorated under care, whereas 66% remained unchanged and 33% showed an improvement in their physiological status. With increasing on-scene time, fewer patients deteriorated and a greater proportion of patients improved.
  
  
  CONCLUSIONS
  Restoring deranged physiology remains a mantra for all critical care practitioners. We have shown that this is also possible in the prehospital context, even when prolonging on-scene time, and after initiating advanced procedures.
authors.affiliation: Department of Emergency Medicine and Prehospital Services, St Olavs Hospital, Trondheim.
authors.forename: Bjørn O
authors.initials: BO
authors.lastname: Reid
authors.affiliation: Department of Research and Development, Norwegian Air Ambulance Foundation, Drøbak.|Department of Health Studies, University of Stavanger, Stavanger.|Department of Anaesthesia, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.
authors.forename: Marius
authors.initials: M
authors.lastname: Rehn
authors.affiliation: Department of Emergency Medicine and Prehospital Services, St Olavs Hospital, Trondheim.
authors.forename: Oddvar
authors.initials: O
authors.lastname: Uleberg
authors.affiliation: Department of Emergency Medicine and Prehospital Services, St Olavs Hospital, Trondheim.|Department of Research and Development, Norwegian Air Ambulance Foundation, Drøbak.
authors.forename: Andreas J
authors.initials: AJ
authors.lastname: Krüger
mesh_terms: D017732:Air Ambulances / Q000592:standards; D002983:Clinical Competence; D003422:Critical Care / Q000592:standards*; D004632:Emergency Medical Services / Q000458:organization & administration*; D004638:Emergency Treatment; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D015601:Injury Severity Score; D033183:Interdisciplinary Communication; D008297:Male; D009104:Multiple Trauma / Q000628:therapy; D009664:Norway; D010348:Patient Care Team / Q000458:organization & administration*; D012680:Sensitivity and Specificity; D015599:Trauma Severity Indices