Long-term follow-up of trauma patients before and after implementation of a Physician-Staffed Helicopter:a prospective observational study

AbstractIntroductionThe first Danish Helicopter Emergency Medical Service (HEMS) was introduced May 1st 2010. The implementation was associated with lower 30-day mortality in severely injured patients. The aim of this study was to assess the long-term effects of HEMS on labour market affiliation and mortality of trauma patients.MethodsProspective, observational study with a maximum follow-up time of 4.5 years. Trauma patients from a 5-month period prior to the implementation of HEMS (pre-HEMS) were compared with patients from the first 12 months after implementation (post-HEMS). All analyses were adjusted for sex, age and Injury Severity Score.ResultsOf the total 1994 patients, 1790 were eligible for mortality analyses and 1172 (n=297 pre-HEMS and n=875 post-HEMS) for labour market analyses. Incidence rates of involuntary early retirement or death were 2.40 per 100 person-years pre-HEMS and 2.00 post-HEMS; corresponding to a hazard ratio (HR) of 0.72 (95% confidence interval (CI) 0.44–1.17; p=0.18). The HR of involuntary early retirement was 0.79 (95% CI 0.44–1.43; p=0.43). The prevalence of reduced work ability after three years were 21.4% vs. 17.7%, odds ratio (OR)=0.78 (CI 0.53–1.14; p=0.20). The proportions of patients on social transfer payments at least half the time during the three-year period were 30.5% vs. 23.4%, OR=0.68 (CI 0.49–0.96; p=0.03). HR for mortality was 0.92 (CI 0.62–1.35; p=0.66).ConclusionsThe implementation of HEMS was associated with a significant reduction in time on social transfer payments. No significant differences were found in involuntary early retirement rate, long-term mortality, or work ability

The impact of a physician-staffed helicopter on outcome in patients admitted to a stroke unit: a prospective observational study

Patient characteristics, patients admitted to the stroke unit and diagnosed with stroke. GEMS: ground emergency medical services; HEMS: helicopter emergency medical services; IQR: interquartile range; AMI: acute myocardial infarction. Co-morbidity was defined as having at least one of the following conditions: diabetes, atrial fibrillation, hypertension, previous myocardial infarction, previous stroke. (DOCX 20 kb

Cardiac transvenous pacing in the retrieval setting: a retrospective case series

Objectives To report on the safety and efficacy of transvenous cardiac pacing wire insertion outside a tertiary hospital by a medical retrieval service. Methods SAAS MedSTAR Emergency Medical Retrieval Service transports symptomatic bradycardic patients in rural South Australia to Adelaide on transvenous pacing for ongoing management. This is a retrospective case review of all transvenous cardiac pacing wires inserted by SAAS MedSTAR between January 2015 and October 2017. Results This study demonstrated successful insertion of cardiac transvenous pacing wires and cardiac capture in 10 of 11 cases (91%) by pre-hospital and retrieval doctors. There were no immediate or long-term complications from insertion. All of the patients were successfully transferred by helicopter or fixed wing to their receiving facility, with nine of the 11 patients (82%) surviving to hospital discharge. Conclusion This paper demonstrates that transvenous cardiac pacing can be safely and successfully implemented for symptomatic patients by pre-hospital and retrieval physicians in the aeromedical retrieval setting