Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.
HEMS vsGEMS
by ground or by air: which is the best
way to take care of traumatized
patients
Narrative review by
Mario Rugn...
References
 On line literature search
 You can find the original articles mentioned in the
presentation at:
http://1drv....
Cost-Effectivness
Cost-Effectiveness of Helicopter Versus Ground Emergency Medical
Services for Trauma Scene Transport in ...
Benefit of
HEMS
Galvagno Critical Care 2013, 17:169
Speed
HEMS mission
 Time to reach the target
 On scene time
 Transport time toTrauma Center
Speed
HEMS to target
 Dispatch
 Take off
 Landing
 On the target
 Nearby area/rendez-vous with ground EMS
 No safe l...
Speed
Time to reach the target
HEMS vs GEMS
Marco A. Diaz, et al. JTrauma. 2005;58:148–153.
Speed
On scene time
Survival benefit of helicopter emergency medical services compared to ground
emergency medical service...
Speed
When Is the Helicopter Faster? A Comparison of Helicopter
and Ground AmbulanceTransportTimes
Marco A. Diaz, Gregory ...
Speed
When Is the Helicopter Faster? A Comparison of Helicopter and Ground Ambulance
TransportTimes
Marco A. Diaz, Gregory...
Speed
When Is the Helicopter Faster? A Comparison of Helicopter and Ground Ambulance
TransportTimes
Marco A. Diaz, Gregory...
Severity
Dennis Den Hartog et al. Injury, Int. J. Care Injured (2015)
 Patients in the HEMS group were more severely
inju...
Severity
HelicopterSceneTransport ofTrauma Patients with NonlifeThreatening Injuries: A Meta-
Analysis
Bryan E. Bledsoe, D...
Trauma
Center
Access
Survival benefit of helicopter emergency medical services
compared to ground emergency medical servic...
Crew
Impact of prehospital mode of transport after severe injury:
A multicenter evaluation from the Resuscitation Outcomes...
Crew
Survival benefit of helicopter emergency medical services
compared to ground emergency medical services in traumatize...
Crew
Survival benefit of helicopter emergency medical services compared to ground
emergency medical services in traumatize...
Crew
Survival benefit of helicopter emergency medical services compared to ground
emergency medical services in traumatize...
Survival
Helicopter emergency medical services for adults with major
trauma (Review 2013)
GalvagnoJr SM,Thomas S, Stephens...
Survival
Survival benefit of helicopter emergency medical
services compared to ground emergency medical
services in trauma...
Survival
Survival benefit of physician-staffed Helicopter
Emergency Medical Services (HEMS) assistance for
severely injure...
Bottom line
Speed
MissionTime
 In case of simultaneous activation HEMS is competitive
for distance >10 miles
 In case of...
Bottom line
Severity
 HEMS patients are generally more severely injured
than GEMS patients
Trauma Center Access
 HEMS tr...
Bottom line
Crew
 More time on scene (beyond the golden hour)
 More procedures performed
 The accuracy of prehospital d...
Bottom line
Survival
 No definitive evidences on HEMS benefits on survival
rate
 Recent literature points on a trend tow...
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
Fata...
Upcoming SlideShare
Loading in …5
×

HEMS vs GEMS

By air or by ground: which is the best way to take care of traumatizated patients

HEMS vs GEMS

  1. 1. HEMS vsGEMS by 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 Visit MEDEST www.medest118.com
  2. 2. References  On line literature search  You can find the original articles mentioned in the presentation at: http://1drv.ms/1GtLgLW
  3. 3. Cost-Effectivness 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.  Conclusions  Compared to ground EMS transport, helicopter scene transport is cost-effective if it results in a reduction in the relative risk of death for seriously injured trauma patients of at least 17% given our model assumptions. This translates into the need to save at least 1.6 lives per 100 patients transported with serious injury. Given current uncertainties, helicopter EMS  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.
  4. 4. Benefit of HEMS Galvagno Critical Care 2013, 17:169
  5. 5. Speed HEMS mission  Time to reach the target  On scene time  Transport time toTrauma Center
  6. 6. Speed 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
  7. 7. Speed Time to reach the target HEMS vs GEMS Marco A. Diaz, et al. JTrauma. 2005;58:148–153.
  8. 8. Speed 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  The extent of medical treatment on-scene which involved intubation, chest and treatment with vasopressors was more extensive in HEMS (p<0.001) resulting in prolonged on-scene time (39.5 62 vs. 28.9 minutes, p<0.001). Impact of prehospital mode of transport after severe injury: A multicenter evaluation from the Resuscitation Outcomes Consortium Eileen M. Bulger, Danielle Guffey. JTrauma Acute Care Surg. 2012 March ; 72(3): 567–803  Patients transported by air had higher rates of prehospital intubation (81% vs. 36%;) received more intravenous fluids (mean 1.3 L vs. 0.8 L; p< 0.001), and had longer prehospital times (mean 76.1 minutes vs. 43.5 minutes; p<0.001).
  9. 9. Speed When Is the Helicopter Faster? A Comparison of Helicopter and Ground AmbulanceTransportTimes Marco A. Diaz, Gregory W. Hendey, and Herbert G. Bivins, JTrauma. 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.
  10. 10. Speed When Is the Helicopter Faster? A Comparison of Helicopter and Ground Ambulance TransportTimes Marco A. Diaz, Gregory W. JTrauma. 2005;58:148 –153. Results:  Ground trans-ports were significantly faster than non simultaneously dispatched ( NSD) helicopter transports at distances under 20 miles. Between 20 and 44 miles, there was no significant difference, and at distances greater than 45 miles, NSD helicopter transport was significantly faster than ground transport  Simultaneously dispatched (SD) helicopter transports became significantly faster than ground transport at distances greater than 10miles from the hospital.
  11. 11. Speed When Is the Helicopter Faster? A Comparison of Helicopter and Ground Ambulance TransportTimes Marco A. Diaz, Gregory W. JTrauma. 2005;58:148 –153. Conclusions:  Ground ambulance transport provided the shortest 911-hospi-tal arrival interval at distances less than 10 miles from the hospital. At distances greater than 10 miles, simultaneously dispatched air transport was faster.  Non simultaneous dispatched helicopter transport was faster than ground if greater than 45 miles from the hospital.
  12. 12. Severity Dennis Den Hartog et al. Injury, Int. J. Care Injured (2015)  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). Andruszkow et al. CriticalCare 2013, 17:R124  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. Bulger et al.JTrauma Acute Care Surg 2012 March  Patients transported by air were more severely injured (mean Injury Severity Score, 30.3 vs. 22.8; p<0.001)
  13. 13. Severity HelicopterSceneTransport ofTrauma Patients with NonlifeThreatening Injuries: A Meta- Analysis Bryan E. Bledsoe, DO, FACEP, A. KeithWesley, MD, FACEP, Marc Eckstein, MD, FACEP,Thomas M. Dunn, PhD, Michael F. O’Keefe, MS JTrauma. 2006;60:1257–1266. Results:  There were 22 studies comprising 37,350 patients that met the inclusion criteria.  According to the ISS, 60.0% [99% confidence interval (CI): 54.5–64.8] of patients had minor injuries,  According to theTS, 61.4% (99%CI: 60.8–62.0) of pa-tients had minor injuries.  According toTRISS methodology, 69.3% (99% CI: 58.5– 80.2) of patients had a greater than 90% chance of survival and thus nonlife threatening injuries.  There were 25.8% (99% CI: 1.0–52.6) of patients discharged within 24 hours after arrival at the trauma center. 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.
  14. 14. Trauma Center Access Survival benefit of helicopter emergency medical services compared to ground emergency medical services in traumatized patients Andruszkow et al. Critical Care 2013, 17:R124  HEMS patients were more often transported to level I trauma centers compared to GEMS (HEMS: 90.1% vs. GEMS: 75.9%). Accordingly, GEMS transported their patients more frequently to level II (HEMS: 9.9% vs. GEMS: 24.1%).
  15. 15. Crew Impact of prehospital mode of transport after severe injury: A multicenter evaluation from the Resuscitation Outcomes Consortium Eileen M. Bulger, Danielle Guffey. JTrauma Acute Care Surg. 2012 March ; 72(3): 567–803 Results  Patients transported by air had higher rates of prehospital intubation (81% vs. 36%; p < 0.001), received more intravenous fluids (mean 1.3 L vs. 0.8 L; p < 0.001), and had longer prehospital times (mean 76.1 minutes vs. 43.5 minutes; p<0.001). Conclusions  However, air medical transported more severely injured patients with more advanced life support procedures and longer prehospital time.
  16. 16. Crew Survival benefit of helicopter emergency medical services compared to ground emergency medical services in traumatized patients Andruszkow et al. Critical Care 2013, 17:R124 Methods:  Traumatized patients (Injury Severity Score; ISS ≥9) primarily treated by HEMS or ground emergency medical services (GEMS) between 2007 and 2009 were analyzed using theTraumaRegister DGU® of the German Society forTrauma Surgery.
  17. 17. Crew Survival benefit of helicopter emergency medical services compared to ground emergency medical services in traumatized patients Andruszkow et al. Critical Care 2013, 17:R124 Results:  More preclinical interventions were found in HEMS transported patients.
  18. 18. Crew Survival benefit of helicopter emergency medical services compared to ground emergency medical services in traumatized patients Andruszkow et al. Critical Care 2013, 17:R124 Results:  Sensitivity and specificity of preclinical diagnoses were not superior in HEMS compared to GEMS.
  19. 19. Survival Helicopter emergency medical services for adults with major trauma (Review 2013) GalvagnoJr SM,Thomas S, Stephens C, Haut ER, Hirshon JM, Floccare D, Pronovost P Author Conclusions  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 GRADEWorking Group criteria due to their non-randomized design.
  20. 20. Survival Survival benefit of helicopter emergency medical services compared to ground emergency medical services in traumatized patients Andruszkow et al. Critical Care 2013, 17:R124 Conclusions:  Transportation by HEMS resulted in a significant survival benefit compared to GEMS patients despite increased injury severity and incidence of posttrau- matic complications (MODS, sepsis).
  21. 21. Survival 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) 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.
  22. 22. Bottom line Speed MissionTime  In case of simultaneous activation HEMS is competitive for distance >10 miles  In case of non simultaneous activation HEMS is faster for distances >45 miles fromTraumaCenter On scene time  HEMS > GEMS
  23. 23. Bottom line Severity  HEMS patients are generally more severely injured than GEMS patients Trauma Center Access  HEMS transported patients have more chances to be referred to a level ITraumaCenter
  24. 24. Bottom line Crew  More time on scene (beyond the golden hour)  More procedures performed  The accuracy of prehospital documented diagnoses was not increased in HEMS compared to GEMS rescue
  25. 25. Bottom line Survival  No definitive evidences on HEMS benefits on survival rate  Recent literature points on a trend toward an increased chances of survival in some categories of trauma patients transported by HEMS
  26. 26. 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 MedicalTransport (2002)

×