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Multicenter Study
. 2021 May 7;29(1):62.
doi: 10.1186/s13049-021-00877-3.

Helicopter emergency medical service dispatch in older trauma: time to reconsider the trigger?

J E Griggs  1   2 , J W Barrett  3   4 , E Ter Avest  5   6 , R de Coverly  5 , M Nelson  5   4   7 , J Williams  4   8 , R M Lyon  5   3 ; Air Ambulance Kent Surrey Sussex
Affiliations
Multicenter Study

Helicopter emergency medical service dispatch in older trauma: time to reconsider the trigger?

J E Griggs et al. Scand J Trauma Resusc Emerg Med. .

Abstract

Background: Helicopter Emergency Medical Services (HEMS) respond to serious trauma and medical emergencies. Geographical disparity and the regionalisation of trauma systems can complicate accurate HEMS dispatch. We sought to evaluate HEMS dispatch sensitivity in older trauma patients by analysing critical care interventions and conveyance in a well-established trauma system.

Methods: All trauma patients aged ≥65 years that were attended by the Air Ambulance Kent Surrey Sussex over a 6-year period from 1 July 2013 to 30 June 2019 were included. Patient characteristics, critical care interventions and hospital disposition were stratified by dispatch type (immediate, interrogate and crew request).

Results: 1321 trauma patients aged ≥65 were included. Median age was 75 years [IQR 69-89]. HEMS dispatch was by immediate (32.0%), interrogation (43.5%) and at the request of ambulance clinicians (24.5%). Older age was associated with a longer dispatch interval and was significantly longer in the crew request category (37 min [34-39]) compared to immediate dispatch (6 min [5-6] (p = .001). Dispatch by crew request was common in patients with falls < 2 m, whereas pedestrian road traffic collisions and falls > 2 m more often resulted in immediate dispatch (p = .001). Immediate dispatch to isolated head injured patients often resulted in pre-hospital emergency anaesthesia (PHEA) (39%). However, over a third of head injured patients attended after dispatch by crew request received PHEA (36%) and a large proportion were triaged to major trauma centres (69%).

Conclusions: Many patients who do not fulfil the criteria for immediate HEMS dispatch need advanced clinical interventions and subsequent tertiary level care at a major trauma centre. Further studies should evaluate if HEMS activation criteria, nuanced by age-dependant triggers for mechanism and physiological parameters, optimise dispatch sensitivity and HEMS utilisation.

Keywords: Critical care interventions; Dispatch sensitivity; Helicopter emergency medical service; Older trauma.

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Conflict of interest statement

JG, ETA, RDC, MN and RL are all employees of Air Ambulance Kent, Surrey and Sussex. JB, JW and MN are employees of South East Coast Ambulance Service NHS Foundation Trust. There were no financial or non-financial conflicts of interest.

Figures

Fig. 1
Fig. 1
Flow chart of study population
Fig. 2
Fig. 2
The distribution of the older trauma cohort when age is plotted against dispatch criteria
See this image and copyright information in PMC

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References

    1. Sammy I, Lecky F, Sutton A, Leaviss J, O’Cathain A. Factors affecting mortality in older trauma patients-a systematic review and meta-analysis. Injury. 2016;47(6):1170–1183. doi: 10.1016/j.injury.2016.02.027. - DOI - PubMed
    1. Trauma Audit and Research Network - Major Trauma in Older People - 2017 Report. 2018 [cited 2018 Feb 15]. Available from: https://www.tarn.ac.uk/Content.aspx?c=3793.
    1. Kehoe A, Smith JE, Edwards A, Yates D, Lecky F. The changing face of major trauma in the UK. Emerg Med J. 2015;32(12):911–915. doi: 10.1136/emermed-2015-205265. - DOI - PMC - PubMed
    1. Hendrickson SA, Osei-Kuffour D, Aylwin C, Fertleman M, Hettiaratchy S. ‘Silver’ trauma: predicting mortality in elderly major trauma based on place of injury. Scand J Trauma Resusc Emerg Med. 2015;23(2):A4. doi: 10.1186/1757-7241-23-S2-A4. - DOI
    1. Schellhaaß A, Popp E. Air rescue: current significance and practical issues. Anaesthesist. 2014;63:971–982. doi: 10.1007/s00101-014-2356-1. - DOI - PubMed

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