보건행정학회지 (Health Policy and Management)

  • 제28권4호
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  • Pages.411-422
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  • 2018
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  • 1225-4266(pISSN)
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  • 2289-0149(eISSN)
한국보건행정학회 (Korean Academy of Health Policy and Management)
권호 표지
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헬리콥터 응급의료서비스의 외상팀 탑승 여부와 외상환자의 생존율

Effectiveness of the Trauma Team-Staffed Helicopter Emergency Medical Service

  • 김태연 (경기도 보건정책과) ;
  • 이상아 (연세대학교 대학원 보건학과) ;
  • 박은철 (연세대학교 보건정책 및 관리연구소) ;
  • 허요 (아주대학교 의과대학 외과학교실 외상외과) ;
  • 정경원 (아주대학교 의과대학 외과학교실 외상외과) ;
  • 권준식 (아주대학교 의과대학 외과학교실 외상외과) ;
  • 문종환 (아주대학교 의과대학 외과학교실 외상외과) ;
  • 김지영 (아주대학교병원 권역외상센터) ;
  • 김주량 (아주대학교병원 권역외상센터) ;
  • 황경진 (아주대학교 의과대학 외과학교실 외상외과) ;
  • 윤성근 (경기도 재난안전본부) ;
  • 이국종 (아주대학교 의과대학 외과학교실 외상외과)
  • Kim, Tea-youn (Health Policy Division, Gyeonggi Province) ;
  • Lee, Sang Ah (Department of Public Health, Yonsei University Graduate School) ;
  • Park, Eun-Cheol (Institute of Health Services Research, Yonsei University) ;
  • Huh, Yo (Division of Trauma Surgery, Department of Surgery, Ajou University School of Medicine) ;
  • Jung, Kyoungwon (Division of Trauma Surgery, Department of Surgery, Ajou University School of Medicine) ;
  • Kwon, Junsik (Division of Trauma Surgery, Department of Surgery, Ajou University School of Medicine) ;
  • Moon, Jonghwan (Division of Trauma Surgery, Department of Surgery, Ajou University School of Medicine) ;
  • Kim, Jiyoung (South Gyeonggi Regional Trauma Center, Ajou University Hospital) ;
  • Kim, Juryang (South Gyeonggi Regional Trauma Center, Ajou University Hospital) ;
  • Hwang, Kyungjin (Division of Trauma Surgery, Department of Surgery, Ajou University School of Medicine) ;
  • Yun, Seong Keun (Gyeonggi Disaster and Safety Headquarters) ;
  • Lee, John Cook-Jong (Division of Trauma Surgery, Department of Surgery, Ajou University School of Medicine)
  • 투고 : 2018.07.31
  • 심사 : 2018.08.21
  • 발행 : 2018.12.31
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초록

Background: Whether there is a difference in outcomes for trauma patients transferring to the helicopter emergency medical service (HEMS) according to their previous team composition is controversial. The purpose of this study is to evaluate the effectiveness of trauma team-staffed-HEMS (TTS-HEMS) when transferring to a trauma center. Methods: A retrospective comparison was conducted on patients transported to a trauma center over a 6-year period by the TTS-HEMS and paramedic-staffed-HEMS (119-HEMS). Inclusion criteria were blunt trauma with age ${\geq}15years$. Patient outcomes were compared with the Trauma and Injury Severity Score (TRISS) (30-day mortality) and the Cox proportional hazard ratio of mortality (in hospital). Results: There were 321 patients of TTS-HEMS and 92 patients of 119-HEMS. The TTS-HEMS group had a higher Injury Severity Score and longer transport time but a significantly shorter time to emergency surgery. The prehospital data showed that the trauma team performed more aggressive interventions during transport. An additional 7.6 lives were saved per 100 TTS-HEMS deployments. However, the TRISS results in the 119-HEMS group were not significant. In addition, after adjusting for confounders, the hazard ratio of mortality in the 119-HEMS group was 2.83 times higher than that in the TTS-HEMS group. Conclusion: HEMS was likely to improve the survival rate of injured patients when physicians were involved in TTS-HEMS. Survival benefits in the TTS-HEMS group appeared to be related to the fact that the trauma team performed both more aggressive prehospital resuscitation and clinical decision making during transportation.

키워드

BGHJBH_2018_v28n4_411_f0001.png 이미지

Figure 1. 2018 1st Regional Trauma Committee of Southern Gyeonggi Regional Trauma Center. Analysis in delayed dispatch time of HEMS (from March 2017 to December 2017). HEMS, helicopter emergency medical service.

Table 1. Baseline characteristics of study groups

BGHJBH_2018_v28n4_411_t0001.png 이미지

Table 2. Comparison of procedures performed procedures between trauma team and 119 paramedic(s) during transfer

BGHJBH_2018_v28n4_411_t0002.png 이미지

Table 3. Outcomes and survival probabilities, the basis of Trauma and Injury Severity Score method in 30-day mortality

BGHJBH_2018_v28n4_411_t0003.png 이미지

Table 4. Cox proportional hazards model for the risk factors associated with mortality of trauma patients with HEMS

BGHJBH_2018_v28n4_411_t0004.png 이미지

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