Helicopter emergency medical services for adults with major trauma.

摘要

Injuries remain an important and often neglected cause of morbidity and mortality worldwide. Helicopter emergency medical services (HEMS) have evolved over the past forty years as an integral part of trauma systems in many developed nations. Helicopters are capable of transporting injured patients significantly faster than ground units, and the speed benefit is more pronounced as distance from a trauma center increases. Additionally, helicopters are staffed by experienced providers who are capable of performing life-saving interventions. Recent research has questioned which traumatically injured patients derive the greatest benefit from the utilization of this limited, expensive, and potentially dangerous resource. The purpose of this research is to expand the science of aeromedical critical care through the cultivation of a versatile and robust research methodology. This thesis consists of three principal parts: 1) a systematic review of the available research regarding HEMS for adults with major trauma, 2) application of state-of-the-art statistical methods, using a very large database, to assess the effectiveness of helicopter vs. ground emergency medical services, and 3) evaluation, through a conceptual framework and narrative review, of a proposal to use an instrument for the assessment of health-related quality of life for HEMS patients. These studies attempt to evaluate HEMS-associated health value through a structured review of the available literature and with a methodologically rigorous study using the largest known aggregation of trauma registry data in the world. The results from these investigations will motivate future research in this area in an effort to improve morbidity and mortality within HEMS systems.