Physician staffed helicopter emergency medical systems can provide advanced trauma life support in mountainous and remote areas

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• 作者：Julia Ausserer^a ; Elizabeth Moritz^a ; Matthias Stroehle^a ; Hermann Brugger^b ; Giacomo Strapazzon^b ; Simon Rauch^b ; Peter Mair^a ; ^{p.mair@tirol-kliniken.at} ; International Alpine Trauma Registry Study GroupFrancesco Bonsante^c ; Manfred Brandstä ; tter^d ; Tomas Dal Cappello^e ; Gerold Drü ; ge^f ; Markus Falk^e ; Ernst Fop^d ; Andreas Frasnelli^g ; Lukas Gasteiger^c ; Elisabeth Gruber^h ; Georg Hoferⁱ ; Wolfgang Lunz^j ; Martin Palma^e ; Franz Ploner^k ; Georg Rammlmair^l ; Alberto Trincanato^e ; Rachel Turner^e ; Peter Zanon^c ; Wolfgang Voelckel^m ; Clemens Denggⁿ ; Margareth Kettner^o
• 关键词：Advanced trauma life support ; Mountain rescue ; Helicopter ; Emergency physician ; Trauma ; Endotracheal intubation ; Volume resuscitation
• 刊名：Injury
• 出版年：2017
• 出版时间：January 2017
• 年：2017
• 卷：48
• 期：1
• 页码：20-25
• 全文大小：253 K
• 卷排序：48

文摘

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.Patients58 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.ResultsPre-hospital time exceeded 90 min in 24 (44%) cases. 31 (53%) patients suffered critical impairment of at least one vital function (systolic blood pressure <90 mmHg, GCS <10, or respiratory rate <10 or >30). 4 (6.9%) of 58 patients died prior to hospital admission. Volume resuscitation was restrictive: 18 (72%) of 25 hypotensive patients received ≤500 ml fluids and blood pressure was increased >90 mmHg at hospital admission in only 9 (36%) of these 25 patients. 8 (50%) of 16 brain trauma patients with a blood pressure <90 mmHg remained hypotensive at hospital admission. Endotracheal intubation was accomplished without major complications in 15 (79%) of 19 patients with a Glasgow Coma Scale score <10. Rope operations were necessary in 40 (69%) of 58 cases and ATLS was started before hoist evacuation in 30 (75%) of them.ConclusionsThe 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.