DOI QR코드

DOI QR Code

The characteristics and clinical outcomes of trauma patients transferred by a physician-staffed helicopter emergency medical service in Korea: a retrospective study

  • Myung Jin Jang (Department of Trauma Surgery, Gachon University Gil Medical Center) ;
  • Woo Sung Choi (Department of Emergency Medicine, Gachon University Gil Medical Center) ;
  • Jung Nam Lee (Department of Trauma Surgery, Gachon University Gil Medical Center) ;
  • Won Bin Park (Department of Emergency Medicine, Gachon University Gil Medical Center)
  • Received : 2023.10.09
  • Accepted : 2023.11.30
  • Published : 2024.06.30

Abstract

Purpose: Helicopter transport with medical teams has been proven to be effective, with improvements in patient survival rates. This study compared and analyzed the clinical characteristics and treatment outcomes of trauma patients transported by doctor helicopters according to whether patients were transferred after a clinical evaluation or without a clinical evaluation. Methods: This study retrospectively reviewed data from the Korean Trauma Data Bank of trauma patients who arrived at a regional trauma center through doctor helicopters from January 1, 2014, to December 31, 2022. The patients were divided into two groups: doctor helicopter transport before evaluation (DHTBE) and doctor helicopter transport after evaluation (DHTAE). These groups were compared. Results: The study population included 351 cases. At the time of arrival at the trauma center, the systolic blood pressure was significantly lower in the DHTAE group than in the DHTBE group (P=0.018). The Injury Severity Score was significantly higher in the DHTAE group (P<0.001), and the accident to trauma center arrival time was significantly shorter in the DHTBE group (P<0.001). Mortality did not show a statistically significant between-group difference (P=0.094). Surgical cases in the DHTAE group had a longer time from the accident scene to trauma center arrival (P=0.002). The time from the accident to the operation room or from the accident to angioembolization showed no statistically significant differences. Conclusions: DHTAE was associated with significantly longer transport times to the trauma center, as well as nonstatistically significant trends for delays in receiving surgery and procedures, as well as higher mortality. If severe trauma is suspected, air transport to a trauma center should be requested immediately after a simple screening test (e.g., mechanism of injury, Glasgow Coma Scale, or Focused Assessment with Sonography in Trauma), which may help reduce the time to definitive treatment.

Keywords

Acknowledgement

The authors received no financial support for this study.

References

  1. Statistics Korea. [Mortality rate by cause of death] [Internet]. Statistics Korea; 2022 [cited 2023 Mar 3]. Available from: https://www.kostat.go.kr/board.es?mid=a10301060200&bid=218&act=view&list_no=427216 
  2. Park K, Lee JS, Kim Y, Kim YI, Kim J. The socioeconomic cost of injuries in South Korea. J Prev Med Public Health 2009;42:5-11. 
  3. Park CY, Yu B, Kim HH, et al. PARK index for preventable major trauma death rate. J Korean Soc Traumatol 2015;28:115-22. 
  4. Park Y, Lee GJ, Lee MA, et al. Major causes of preventable death in trauma patients. J Trauma Inj 2021;34:225-32. 
  5. National Emergency Medical Center. [Statistical year book of Korean Trauma Data Bank, 2021]. National Emergency Medical Center of Korea; 2022. 
  6. Park SK, Uhm TH. Predictors of mortality by age in patients with major trauma in Korea. Korean J Emerg Med Ser 2023;27:91-100. 
  7. Kang KG, Cho JS, Kim JJ, et al. Association between helicopter versus ground emergency medical services in inter-hospital transport of trauma patients. J Korean Soc Traumatol 2015;28:108-14. 
  8. Hesselfeldt R, Steinmetz J, Jans H, et al. Impact of a physician-staffed helicopter on a regional trauma system: a prospective, controlled, observational study. Acta Anaesthesiol Scand 2013;57:660-8. 
  9. Den Hartog D, Romeo J, Ringburg AN, Verhofstad MH, Van Lieshout EM. Survival benefit of physician-staffed helicopter emergency medical services (HEMS) assistance for severely injured patients. Injury 2015;46:1281-6. 
  10. Jung K, Huh Y, Lee JC, et al. Reduced mortality by physician-staffed HEMS dispatch for adult blunt trauma patients in Korea. J Korean Med Sci 2016;31:1656-61. 
  11. Taylor C, Jan S, Curtis K, et al. The cost-effectiveness of physician staffed helicopter emergency medical service (HEMS) transport to a major trauma centre in NSW, Australia. Injury 2012;43:1843-9. 
  12. Hankins D. Cost-effectiveness of physician-staffed HEMS transport to a major trauma center. Air Med J 2013;32:64-5. 
  13. Kim J, Heo Y, Lee JC, et al. Effective transport for trauma patients under current circumstances in Korea: a single institution analysis of treatment outcomes for trauma patients transported via the domestic 119 service. J Korean Med Sci 2015;30:336-42. 
  14. Schluter PJ. The Trauma and Injury Severity Score (TRISS) revised. Injury 2011;42:90-6. 
  15. Weinlich M, Martus P, Blau MB, et al. Competitive advantage gained from the use of helicopter emergency medical services (HEMS) for trauma patients: evaluation of 1724 patients. Injury 2019;50:1028-35. 
  16. Andruszkow H, Lefering R, Frink M, et al. Survival benefit of helicopter emergency medical services compared to ground emergency medical services in traumatized patients. Crit Care 2013;17:R124. 
  17. Harmsen AM, Giannakopoulos GF, Moerbeek PR, Jansma EP, Bonjer HJ, Bloemers FW. The influence of prehospital time on trauma patients outcome: a systematic review. Injury 2015;46:602-9. 
  18. Harvin JA, Maxim T, Inaba K, et al. Mortality after emergent trauma laparotomy: a multicenter, retrospective study. J Trauma Acute Care Surg 2017;83:464-8. 
  19. Clarke JR, Trooskin SZ, Doshi PJ, Greenwald L, Mode CJ. Time to laparotomy for intra-abdominal bleeding from trauma does affect survival for delays up to 90 minutes. J Trauma 2002;52:420-5. 
  20. Netherton S, Milenkovic V, Taylor M, Davis PJ. Diagnostic accuracy of eFAST in the trauma patient: a systematic review and meta-analysis. CJEM 2019;21:727-38. 
  21. Coccolini F, Stahel PF, Montori G, et al. Pelvic trauma: WSES classification and guidelines. World J Emerg Surg 2017;12:5. 
  22. Geeraerts T, Chhor V, Cheisson G, et al. Clinical review: initial management of blunt pelvic trauma patients with haemodynamic instability. Crit Care 2007;11:204. 
  23. Hsu SD, Chen CJ, Chou YC, Wang SH, Chan DC. Effect of early pelvic binder use in the emergency management of suspected pelvic trauma: a retrospective cohort study. Int J Environ Res Public Health 2017;14:1217.