Trauma Patients Survival Benefits Of HEMS Compared To GEMS survival rate

Prehospital trauma care is still a matter of ongoing debate with inconsistent evidence comparing the impact of emergency transport with helicopter and ground emergency transport on the outcome of trauma patients.

Some researchers, in 2013, performed a study to compare the effects of HEMS and GEMS on outcome after trauma complained by patients, and which is still a current topic to discuss. Link of the complete study paper, references and authors at the end of the article.

This study was able to demonstrate that transportation by helicopter emergency medical services resulted in a significant survival benefit compared to ground emergency medical services patients despite increased injury severity and incidence of post-traumatic complications (MODS, sepsis).

 

Verify HEMS benefits

Reduced rescue times and increased catchment area represent presumable specific advantages of helicopter emergency medical services. In contrast, the availability of HEMS is connected to a high financial burden and depends on the weather, day time and controlled visual flight rules.

Traumatized patients (Injury Severity Score; ISS ≥9) primarily treated by helicopter emergency medical services or ground emergency medical services between 2007 and 2009 were analyzed using the TraumaRegister DGU® of the German Society for Trauma Surgery.

Complications during hospital treatment included sepsis and organ failure according to the criteria of the American College of Chest Physicians/Society of Critical Care Medicine (ACCP/SCCM) consensus conference committee and the Sequential Organ Failure Assessment (SOFA) score.

HEMS vs GEMS: the results

Although helicopter emergency medical services patients were more seriously injured and had a significantly higher incidence of MODS and sepsis, these patients demonstrated a survival benefit compared to GEMS.

A total of 13,220 patients with traumatic injuries were included in the present study. Of these, 62.3% (n = 8,231) were transported by GEMS and 37.7% (n = 4,989) by helicopter emergency medical services. The latter were more seriously injured compared to the former (ISS 26.0 vs. 23.7, P < 0.001) with more severe chest and abdominal injuries.

The extent of medical treatment on-scene, which involved intubation, chest and treatment with vasopressors, was more extensive in helicopter emergency medical services (P < 0.001) resulting in prolonged on-scene time (39.5 vs. 28.9 minutes, P < 0.001).

During their clinical course, helicopter emergency medical services patients more frequently developed multiple organ dysfunction syndrome (MODS) (HEMS: 33.4% vs. GEMS: 25.0%; P < 0.001) and sepsis (HEMS: 8.9% vs. GEMS: 6.6%, P < 0.001) resulting in an increased length of ICU treatment and in-hospital time (P < 0.001).

Multivariate logistic regression analysis found that after adjustment by 11 other variables the odds ratio for mortality in helicopter emergency medical services was 0.75 (95% CI: 0.636 to 862).

Afterwards, a subgroup analysis was performed on patients transported to level I trauma centers during daytime with the intent of investigating a possible correlation between the level of the treating trauma center and post-traumatic outcome.

According to this analysis, the Standardized Mortality Ratio, SMR, was significantly decreased following the Trauma Score and the Injury Severity Score (TRISS) method (HEMS: 0.647 vs. GEMS: 0.815; P = 0.002) as well as the Revised Injury Severity Classification (RISC) score (HEMS: 0.772 vs. GEMS: 0.864; P = 0.045) in the helicopter emergency medical services group.

 

 

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SOURCE

BIOMED CENTRAL

Sequential Organ Failure Assessment (SOFA) score

 

 

 

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