hems vs gems by ground or by air: which is the best way to take care of traumatized patients

HEMS vs GEMSby ground or by air: which is the best way

to take care of traumatized patients

Narrative review by

Mario Rugna

Physician

GEMS and HEMS

Florence, Italy

Costvs

Effectivness

Reduction in the relative risk of deathfor seriously injured trauma patients of at least 17%

Need to save at least 1.6 lives per 100 patients transported with serious injury.

Cost-Effectiveness of Helicopter Versus Ground Emergency Medical Services for Trauma Scene Transport in the United States M. Kit Delgado, MD, Kristan L. Staudenmayer, MD, N. Ewen Wang

Ann Emerg Med. 2013 October ; 62(4): 351–364.e19.

Benefits of

HEMS

Galvagno Critical Care 2013, 17:169

HEMS to target Dispatch Take off Landing

On the target Nearby area/rendez-vous with

ground EMS No safe landing space (Winch,

hovering )

Dispatch Take-off Landing

Speed

Marco A. Diaz, et al. J Trauma. 2005;58:148–153.

Time to reach the targetHEMS vs GEMSSpeed

When Is the Helicopter Faster? A Comparison of Helicopterand Ground Ambulance Transport TimesMarco A. Diaz, Gregory W. Hendey, and Herbert G. Bivins, J Trauma. 2005;58:148 –153.

Time from 911 call to hospital arrival versus distance from hospital, for ground, non simultaneously dispatched (NSD), and simultaneously

dispatched (SD) helicopter transports. Each bar rep-resents the mean time from 911 call to hospital arrival, in minutes, with 95% confidence intervals.

Speed

Non simultaneously dispatched ( NSD)Under 20 miles ground trans-ports were significantly faster . Between 20 and 44 miles, no significant differenceAt distances greater than 45 miles, helicopter transport was significantly faster

When Is the Helicopter Faster? A Comparison of Helicopterand Ground Ambulance Transport TimesMarco A. Diaz, Gregory W. Hendey, and Herbert G. Bivins, J Trauma. 2005;58:148 –153

Simultaneously dispatched (SD)Helicopter transports became significantly faster at distances greater than 10miles from the hospital.

Speed

SeverityHEMS

22 studies comprising 37,350 patients.

Conclusions:

The majority of trauma patients transported from the scene by helicopter have nonlife-threatening injuries.

Efforts to more accurately identify those patients who would benefit most from helicopter transport from the accident scene to the trauma center are needed to reduce helicopter overutilization.Helicopter Scene Transport of Trauma Patients with Nonlife Threatening Injuries: A Meta-Analysis Bryan E. Bledsoe,

DO, FACEP, A. Keith Wesley, MD, FACEP, Marc Eckstein, MD, FACEP, Thomas M. Dunn, PhD, Michael F. O’Keefe, MS J Trauma. 2006;60:1257–1266.

Patients in the HEMS group were more severely injured (ISS 26 versus 22; p < 0.001) and had more disturbed vital parameters (lower GCS and RTS; p < 0.001).

Dennis Den Hartog et al. Injury, Int. J. Care Injured (2015)

Patients treated by HEMS were more seriously injured compared to GEMS (ISS 26.0 vs. 23.7, P < 0.001) with more severe chest and abdominal injuries.

Andruszkow et al. Critical Care 2013, 17:R124

Patients transported by air were more severely injured(mean Injury Severity Score, 30.3 vs. 22.8; p<0.001)

Bulger et al. J Trauma Acute Care Surg 2012 March

SeverityHEMS vs GEMS

Air medical transported more severely injured patients who received more advanced life support procedures and had

longer prehospital time.Crew

Crew

The intubation, chest drainage and treatment with vasopressors was more extensive in HEMS treated patients resulting in prolonged on-scene time

Survival benefit of helicopter emergency medical services compared to ground emergency medical services in traumatized patients Andruszkow et al. Critical Care 2013, 17:R124

Patients transported by air had higher rates of prehospital intubation (81% vs. 36%) received more intravenous fluids and had longer prehospital times

Impact of prehospital mode of transport after severe injury: A multicenter evaluation from the Resuscitation Outcomes Consortium Eileen M. Bulger, Danielle Guffey. J Trauma Acute Care Surg.

2012 March ; 72(3): 567–803


Crew

Sensitivity and specificity of preclinical diagnoses were not superior in HEMS compared to

GEMS.


Crew

Trauma Center Access

HEMS patients were more often transported to level I trauma centers compared to GEMS.

Accordingly, GEMS transported their patients more frequently to level II.


Traumatized patients (Injury Severity Score; ISS ≥9) primarily treated by HEMS or ground emergency medical services (GEMS) between 2007 and 2009 were analyzed using the Trauma Register DGU® of the German Society for Trauma Surgery.

Conclusions:

Transportation by HEMS resulted in a significant survival benefit compared to GEMS patients despite increased injury severity and incidence of post-trau-matic complications (MODS, sepsis).


Survival

Level 1 Trauma Centre serving a region with 4.9 million inhabitants in Netherlands. All consecutive severely injured trauma patients (Injury Severity Score (ISS) >15) present-ing at the Emergency Department between October 1, 2000 and February 28, 2013.

Conclusions:

The present study indicates an additional 5.33 lives saved per 100 dispatches of the physician-staffed HEMS.

Given the excellent statistical power of this study (>90%), physician-staffed HEMS is confirmed to be an evidence-based valuable addition to the EMS systems in saving lives of severely injured patients.

Survival benefit of physician-staffed Helicopter Emergency Medical Services (HEMS) assistance for severely injured patients Dennis Den Hartog,et al. Injury, Int. J. Care Injured (2015)

Survival

An accurate composite estimate of the benefit of HEMS could not be determined

Although five of the nine multivariate regression studies indicated improved survival associated with HEMS, the remainder did not

All were subject to a low quality of evidence as assessed by the GRADE Working Group criteria due to their non-randomized design

Helicopter emergency medical services for adults with major trauma (Review 2013) Galvagno Jr SM, Thomas S, Stephens C, Haut ER, Hirshon JM, Floccare D, Pronovost P

Survival

Reduction in the relative risk of death for seriously injured trauma patients of at least 17%

Need to save at least 1.6 lives per 100 patientstransported with serious injury

Given current evidence, it is not clear that HEMS achieves this mortality or disability reduction

Reducing over-triage of minor injury patients to HEMS would improve its cost-effectiveness

Cost-Effectiveness of Helicopter Versus Ground Emergency Medical Services for Trauma Scene Transport in the United States M. Kit Delgado, MD, Kristan L. Staudenmayer, MD, N. Ewen Wang Ann Emerg Med. 2013 October ; 62(4): 351–364.e19.

Costvs

Effectivness

Safety

1

6

12 12

19

0

2

4

6

8

10

12

14

16

18

20

Airline

Commuter

Ground Ambulance

All Helicopters

Medical Helicopters

Fatal crashes per million of flight

Source: AMPA, A Safety Review and Risk Assessment in Air Medical Transport (2002)

References

On line literature search:

You can find the original articles mentioned in the presentation at:

https://1drv.ms/f/s!Ahr6pKBP0QDXgndAZD6O38sUqWNx

Thanks

Mario Rugna

118 Firenze Soccorso ed Elisoccorso

https://1drv.ms/f/s!Ahr6pKBP0QDXgndAZD6O38sUqWNx

hems vs gems by ground or by air: which is the best way to take care of traumatized patients

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