The experience of Teesside helicopter emergency services: doctors do not prolong prehospital on-scene times.

摘要

BACKGROUND: The benefits of helicopter emergency medical services (HEMSs) attending the severely injured have been documented in the past. The benefits of doctors attending HEMS casualties have been demonstrated in particular in inner-urban and metropolitan areas. However, for UK regions with potentially less major trauma, concerns have been raised by ambulance services that a willingness of doctors to "stay and play" may lead to unnecessary delays on-scene without any additional benefit to the patient. AIMS: To identify factors that do prolong on-scene time, establish whether doctors "stay and play" on-scene compared with paramedics and document how often advanced medical skills may have to be used by HEMS doctors working outside the London HEMS environment. METHODS: Patient report form data were studied with regard to the number of and mean on-scene times of missions flown to (A) road-traffic collisions (RTCs), (B) other trauma calls (OTCs) and (C) medical emergencies. Trauma missions (categories A and B) were further subcategorised with regard to associated patient entrapment. Any advanced medical interventions (AMIs) performed by HEMS doctors were recorded and categorised. Finally, we looked at the difference in on-scene times for physician-paramedic partnerships (PPPs) and conventional paramedic crews (CPCs) for the above categories and subcategories. RESULTS: A total of 203 patient report forms were identified and examined. In all, 44.3% of missions were flown to RTCs with a further 44.3% for OTCs and 11.4% to medical emergencies. AMIs were performed by HEMS doctors in 34.1% of PPP missions, with a prehospital rapid sequence induction rate of 3.8%. Overall mean on-scene time was 25 min, with no difference for PPP and CPC missions. The mean on-scene time was prolonged by 6 min for RTCs (p = 0.006) and by 23 min for patient entrapment (p<0.001). No significant differences were found for the comparison between PPPs and CPCs in any of the subgroups A-C. However, there seemed to be a trend towards reduced on-scene times of PPPs for medical emergencies and patient entrapments. DISCUSSION: This study did not show any significant prolongation of mean on-scene times for PPP missions either overall or for any of the subgroups A-C. The fact that AMIs were performed in a large number of missions attended by HEMS doctors seems to further justify their current role in providing improved care at the roadside without leading to any delays in transfer to definitive care.