Physician staffed helicopter emergency medical systems can provide advanced trauma life support in mountainous and remote areas
| Autor: | Georg Rammlmair, Giacomo Strapazzon, Ernst Fop, J. Ausserer, Clemens Dengg, Margareth Kettner, Wolfgang Lunz, Franz Ploner, Manfred Brandstätter, Elisabeth Gruber, Peter Zanon, Elizabeth Moritz, Markus Falk, Wolfgang G. Voelckel, Martin Palma, Simon Rauch, Alberto Trincanato, Andreas Frasnelli, Francesco Bonsante, Gerold Drüge, Lukas Gasteiger, Georg Hofer, Rachel Turner, Hermann Brugger, Matthias Stroehle, Peter Mair, Tomas Dal Cappello |
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| Rok vydání: | 2017 |
| Předmět: |
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Emergency Medical Services Resuscitation medicine.medical_specialty Wilderness Medicine Poison control Occupational safety and health Evidence-Based Emergency Medicine 03 medical and health sciences 0302 clinical medicine Physicians Outcome Assessment Health Care Humans Medicine 030212 general & internal medicine General Environmental Science Mountain rescue Multiple Trauma business.industry Major trauma 030208 emergency & critical care medicine Air Ambulances Middle Aged medicine.disease Mountaineering Advanced trauma life support Blood pressure Austria Advanced Trauma Life Support Care Emergency medicine Feasibility Studies General Earth and Planetary Sciences Injury Severity Score Female Medical emergency business |
| Zdroj: | Injury. 48:20-25 |
| ISSN: | 0020-1383 |
| Popis: | In remote and mountainous areas, helicopter emergency medical systems (HEMS) are used to expedite evacuation and provide pre-hospital advanced trauma life support (ATLS) in major trauma victims. Aim of the study was to investigate feasibility of ATLS in HEMS mountain rescue missions and its influence on patient condition at hospital admission.58 major trauma victims (Injury Severity Score ≥16), evacuated by physician staffed HEMS from remote and mountainous areas in the State of Tyrol, Austria between 1.1.2011 and 31.12.2013.Pre-hospital time exceeded 90min in 24 (44%) cases. 31 (53%) patients suffered critical impairment of at least one vital function (systolic blood pressure90mmHg, GCS10, or respiratory rate10 or30). 4 (6.9%) of 58 patients died prior to hospital admission. Volume resuscitation was restrictive: 18 (72%) of 25 hypotensive patients received ≤500ml fluids and blood pressure was increased90mmHg at hospital admission in only 9 (36%) of these 25 patients. 8 (50%) of 16 brain trauma patients with a blood pressure90mmHg remained hypotensive at hospital admission. Endotracheal intubation was accomplished without major complications in 15 (79%) of 19 patients with a Glasgow Coma Scale score10. Rope operations were necessary in 40 (69%) of 58 cases and ATLS was started before hoist evacuation in 30 (75%) of them.The frequent combination of prolonged pre-hospital times, with critical impairment of vital functions, supports the need for early ATLS in HEMS mountain rescue missions. Pre-hospital endotracheal intubation is possible with a high success and low complication rate also in a mountain rescue scenario. Pre-hospital volume resuscitation is restrictive and hypotension is reversed at hospital admission in only one third of patients. Prolonged pre-hospital hypotension remains an unresolved problem in half of all brain trauma patients and indicates the difficulties to increase blood pressure to a desired level in a mountain rescue scenario. Despite technical considerations, on-site ATLS is feasible for an experienced emergency physician in the majority of rope rescue operations. |
| Databáze: | OpenAIRE |
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