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Thursday, April 30, 2015

Physician Staffed HEMS for Trauma...

Dr. Bill Hinckley (Retrievalist, Flight Doctor, Medical Director at UC Health Air Care and Mobile Care - past president AMPA) notes on LinkedIn that the results of a study on the benefits of having a physician aboard a medical helicopter are being published in the journal "Injury."

The study indicates that having a physician on board resulted in an additional 5.33 lives saved per 100 flights to pick up severely injured patients. This is a significant number.

While flying with Geisinger Life Flight in 1999 and 2000, I routinely carried a resident in addition to the normal crew of flight nurse and flight paramedic. I thought then and think now that this practice was good for the resident, good for the patient, and good for HEMS/HAAO - as these doctors got to see first-hand how helicopters influence healthcare.

What are your thoughts?

Leave us a comment...

Dr. Bill writes,

Thanks for posting this, Dan. 

First, we need to clarify slightly exactly what this particular study was comparing. The control group was ground ambulance transport with paramedics. The experimental group was bringing a physician-paramedic HEMS team to the scene, by helicopter when possible but sometimes by ground in unflyable weather, and then transporting the patient accompanied by the HEMS team to the trauma center, usually by ground. This is a common model in Europe, but definitely quite different than the "typical" US model of nurse-paramedic HEMS teams that essentially never transport patients by ground. (Obviously, many exceptions to this "typical" model exist in the US, including here in Cincinnati.) So we can't necessarily extrapolate too much from this Dutch study to our situation in the US. It is convincing, however, that the concept of bringing critical care to the patient as opposed to just bringing the patient to critical care is a concept that can save lives.

However, looking more broadly at all of the HEMS outcomes literature in trauma that's been published since 1980, in my opinion the question of whether or not HEMS saves lives in trauma has been repeatedly asked and answered to the point that we know it to be true with as much certainty as we know anything in the realm of EMS (both here in the US and abroad). How much of the mortality benefit comes from time savings vs bringing additional clinical capability to the patient prehospitally remains up for discussion, though I certainly believe the latter to be the more important of the two. We also know that of the 12 studies that have specifically compared HEMS-without-a-doctor to HEMS-with-a-doctor in trauma pts, 10 of the 12 studies showed mortality improvement with the doctor on board. I suspect these benefits extend far outside the realm of trauma to other time-dependent critical illnesses, though very little outcomes research has examined that question to date. 

With that said, HEMS overutilization and HEMS safety remain as very significant issues here in the US, on which our community must continue to work diligently to improve to the level of our European and Australian colleagues. We have a long way to go.

Dan, thanks for doing what you do!

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