Provincial air ambulance transports of injured patients were quality reviewed prospectively to determine utilization and appropriateness of care.
All trauma air ambulance transports over a 2-month span were reviewed prospectively. Revised Trauma Score, Injury Severity Score, probability of survival, prehospital time, distance of transport, procedures performed, and outcome were determined. Quality control questions were asked of the sending and receiving physicians.
The majority of air ambulance transports reviewed (N = 97) were indicated for mechanism and severity of injury. Economics and requirement for advanced medical care were indications in only 15%. Physicians tended to perform more advanced procedures, likely related to higher patient Injury Severity Score (23 vs. 15, p = NS). Four problems with air ambulance access were identified. The overtriage rate was 5%. Inappropriate patient care was documented in six (6%) cases; a physician was present for only one of these.
A low overtriage rate was documented, raising concerns that the undertriage rate may be too high. Injured patients air transported without physician accompaniment more often received inappropriate care, suggesting that physician accompaniment is beneficial.
To review and characterize 4 years of experience with suggested nontraumatic aortic emergencies (dissections/ruptures) transported by a new, provincially dedicated rotor-wing air medical program
Retrospective 4-year review of air medical program's mission records and review of related hospital records. Patients listed as suspected aortic emergencies (nontraumatic) in the air medical records were included. Mission records were reviewed for EMS diagnosis, blood pressures before and after transport, transport times, and mortality. Hospital records were reviewed for diagnosis, interventions/treatment, and mortality. Blood pressures below 80 mmHg systolic were considered hemodynamically unstable.
A cohort of 34 patients were identified, of whom 31 (91%) arrived at the hospital alive. Twenty-five patients (74%) arrived hemodynamically stable, with a mean out-of-hospital time of 60 minutes, and nine patients (26%) were hemodynamically unstable (mean out-of-hospital time was 54 minutes). No significant difference arose in times between these two groups (P = 0.16). Overall mortality was 53% (18). Differences in transport time between survivors and deaths was not statistically significant (P = 0.93). The diagnoses on admission to hospital: 14 (41%) were RAAA, five (15%) AAA no rupture, eight (24%) aortic dissections, and four (12%) had no aortic pathology. Seventeen patients (50%) received emergent surgical intervention. The EMS diagnosis was correct in 76% of cases.
Our program transported 34 suspected aortic emergencies of which 17 were immediate surgical candidates on arrival. Aortic emergencies are not infrequent within our program. Specific policies and procedures based on continuing quality review should be in place to optimize the transport and care of these patients.
The aim of this study was to describe principal problems and to analyse transport times, stabilizing procedures, adverse events during transfer, outcome, effectiveness and the care of infants transferred by air from district general hospitals and maternity homes to a central hospital. Transfer times, equipment adverse events and clinical deterioration were recorded as they occurred. Data regarding clinical problems, diagnoses and outcome were collected retrospectively from hospital records. During the study period (1984-95) 275 infants (267 transports) were transferred by fixed-wing aircraft (233) or helicopter (34). Median time from request of transfer to arrival of the transport team (usually a neonatal nurse and a paediatrician) was 120 min, median stabilizing time 60 min. Ninety-six infants (35%) were intubated, 62 (22.5%) by the transport team. During 34 transports (12.7%), equipment-related adverse events occurred making six infants worse. Ten more infants deteriorated during transit. A significant correlation between birthweight and after-transfer temperature was recorded. After-transfer temperature for very low birthweight (
INTRODUCTION: An important factor determining survival after out-of-hospital cardiac arrest is how fast the ambulance personnel can reach the patient. MATERIALS AND METHODS: In a two-year period between 1996 and 1998, all ambulance calls to patients with out-of-hospital cardiac arrest in Oslo were evaluated. Of 1,026 cardiac arrests, 130 were excluded because of missing data. RESULTS: The median ambulance response interval was 7.2 min (5.7-9.0 as 25-75% percentiles). There was a tendency to shorter response intervals to the central parts of Oslo with medians between 3 and 4 min, while 14 more peripheral boroughs had median response intervals over 8 min. Of the 627 cases where the ambulance starting point was registered, 76% were from the only ambulance station in Oslo, located downtown. INTERPRETATION: In our opinion, the median ambulance response interval is unsatisfactory in large parts of Oslo, as a long response time gives a dramatically lower survival rate after cardiac arrest. A reorganisation and decentralization of the Oslo Emergency Medical Service System seems necessary.
