Further evidence from the UK shows that patients with acute traumatic brain injury suffer delays in the neurosurgical evacuation of intracranial haematomas which are increased from an average of 3.7 hours to 5.4 hours if they have to undergo interhospital transfer. Coordinated regional trauma systems please!
A prospective study of the time to evacuate acute subdural and extradural haematomas.
Anaesthesia. 2009 Mar;64(3):277-81
171 rural Australian HEMS missions were retrospectively analysed. Some of the data contrast starkly with the more limelight-occupying urban services: average time from dispatch to scene was 48 minutes, average scene time was 50 mins, and average total distance flown was 160 nautical miles (297 km!) – the longest reported in the literature. There was no difference in injury severity between physician-staffed and paramedic-staffed missions, and no difference in mortality. When transport times for distances less than 50km from the hospital were compared, road responses were significantly faster than helicopter dispatch, whereas helicopter use created significant time savings at distances over 100km. The authors suggest that in the absence of special circumstances, a helicopter response within 100 km from base does not improve time to definitive care. They also recommend caution in mandating physician staffing of HEMS, particularly in environments with a limited pool of critical care doctors.
Helicopter use in rural trauma
Emerg Med Australas. 2008 Dec;20(6):494-9