Short-term outcome in major trauma: land versus air emergency medical rescue in Tuscany

Introduction

Trauma is the major cause of death for people younger than 40 years in developed counties. In Italy an incidence of 120 deaths per 100,000 inhabitants for trauma is reported. An efficient emergency medical response system (EMRS) must therefore be assured in order to provide adequate treatment on the scene and allow a quick rescue to a referral hospital centre.

Methods

The area of Florence in Tuscany consists of a population of 1.5 million inhabitants. In this area the EMRS is provided by a network of land ambulances staffed with an emergency physician and a helicopter with an intensivist on board.

In this study we considered all 291 trauma patients initially admitted to the Emergency Department (ED) and subsequently admitted to the eight-bed ICU of Careggi Hospital in Florence in the period from January 2003 to June 2005. Two groups of patients were considered: 144 patients rescued by the helicopter (group A) and 147 patients rescued by land (group B). The two groups were confronted for the category of trauma, GCS, SpO₂, fluid resuscitation volume, mean artery pressure (MAP), on-scene intubation, intubation within 5 min of arrival at the ED, scene time, lactates at ED admission, ICU LOS, and ICU mortality.

Results

The groups' results were comparable for sex, age, trauma severity scoring, GCS and mean ICU LOS (group B 11.3 ± 10.5 days; group A 9.1 ± 7.9 days). Statistically significant differences* in the two groups were reported concerning the following variables: SpO₂ (group A 95.85% ± 5.21; group B 93.53% ± 8.06*); time on scene (group B 30.3 min; group A 36.52 min*); fluid resuscitation volume and MAP (group B 916.5 ml ± 513.16 and 89.9 mmHg ± 14.5; group A 1122.7 ml ± 564.37 and 92.7 mmHg ± 20.3); out-of-hospital intubation (group B 29%; group A 56.25%*); intubation in the ED (group B 40.8%; group A 11.1%*); lactates at ED admission (group B 3.06; group A 2.0*); and ICU mortality (group B 19.2%*; group A 13.2%).

Conclusion

In our model, air rescue with a helicopter with an intensivist on board assures a higher standard of care, in comparison with land rescue. These achievements positively affect the outcome, with a decrease in ICU LOS and mortality.