Helicopter emergency medical services demonstrate reduced time to emergency anaesthesia in an undifferentiated trauma population: a retrospective observational analysis across three major trauma networks

Daniel Heritage; Joanne Griggs; Jack Barrett; Scott Clarke; Rory Carroll; Richard Lyon; Duncan Bootland

doi:10.1186/s13049-024-01313-y

Helicopter emergency medical services demonstrate reduced time to emergency anaesthesia in an undifferentiated trauma population: a retrospective observational analysis across three major trauma networks

Scand J Trauma Resusc Emerg Med. 2024 Dec 27;32(1):138. doi: 10.1186/s13049-024-01313-y.

Authors

Daniel Heritage¹, Joanne Griggs^{2

3}, Jack Barrett^{4

5}, Scott Clarke⁴, Rory Carroll⁶, Richard Lyon^{4

7}, Duncan Bootland^{4

1}

Affiliations

¹ University Hospital Sussex, Brighton and Hove, Brighton, UK.
² Air Ambulance Charity Kent Surrey Sussex, Redhill Aerodrome, Redhill, Surrey, RH1 5YP, UK. jogriggs@aakss.org.uk.
³ Department of Health Sciences, University of Surrey, Guildford, GU2 7XH, UK. jogriggs@aakss.org.uk.
⁴ Air Ambulance Charity Kent Surrey Sussex, Redhill Aerodrome, Redhill, Surrey, RH1 5YP, UK.
⁵ South East Coast Ambulance Foundation Trust, Crawley, UK.
⁶ St George's Hospital, Tooting, Blackshaw Road, London, SW17 0QT, UK.
⁷ Department of Health Sciences, University of Surrey, Guildford, GU2 7XH, UK.

Abstract

Background: Early rapid sequence induction of anaesthesia (RSI) and tracheal intubation for patients with airway or ventilatory compromise following major trauma is recommended, with guidance suggesting a 45-min timeframe. Whilst on-scene RSI is recommended, the potential time benefit offered by Helicopter Emergency Medical Services (HEMS) has not been studied. We compared the time from 999/112 emergency call to delivery of RSI between patients intubated either in the Emergency Department or pre-hospital by HEMS.

Methods: A retrospective observational cohort study of major trauma patients in South-East England who received a pre-hospital RSI (PHRSI) or Emergency Department RSI (EDRSI) between 2 January 2018 and 24 September 2019. Data were extracted from the UK Trauma Audit and Research Network database. The primary outcome was the time from emergency call to delivery of RSI. Secondary outcomes included mortality at 30-days or hospital discharge, time from arrival of service at hospital or scene to RSI, time from emergency call to Computerised Tomography scan, and conveyance interval. Linear regression was used to model time to RSI in both groups.

Results: Of 378 eligible patients, 209 patients met inclusion criteria. 103 received a PHRSI and 106 received an EDRSI. Most patients were male (n = 171, 82%) and the median age was 48 years (IQR 28-65). 94% sustained a blunt injury mechanism and head was the most injured body region for both cohorts (n = 134, 64%). 63% (n = 67) of patients receiving a PHRSI were conveyed by helicopter. PHRSI was delivered significantly earlier with a median of 64 [IQR 51-75] minutes (95% CI, 60-68) compared with EDRSI with a median of 84 [IQR 68-113] minutes (95% CI, 76-94), p < 0.001).

Conclusion: Major trauma patients who had a pre-hospital RSI received this time-critical intervention sooner after their injury than those who received an emergency anaesthetic after conveyance to a specialist hospital. Patient outcome benefit of HEMS delivered early RSI should be explored.

Keywords: Anaesthesia; Helicopter emergency medical services; Pre-hospital; Trauma.

Publication types

Observational Study

MeSH terms

Adult
Aged
Air Ambulances*
Emergency Medical Services*
England / epidemiology
Female
Humans
Intubation, Intratracheal
Male
Middle Aged
Rapid Sequence Induction and Intubation / methods
Retrospective Studies
Time Factors
Time-to-Treatment
Wounds and Injuries / therapy