Cost-benefit of trained transport teams: estimates for head-injured children

Prehosp Emerg Care. Jan-Mar 2001;5(1):1-5. doi: 10.1080/10903120190940227.

Abstract

Introduction: Care during transport influences the outcome of head-injured children. Secondary adverse events, e.g., hypotension and hypoxia, worsen morbidity and mortality. Trained transport teams lower the incidence of such secondary "insults."

Objective: To estimate the cost-benefit of improved care from trained escorts.

Methods: The setting was a provincial air ambulance service during transition to trained pediatric escort paramedics. A retrospective review of transport and hospital records for a 12-month period was conducted. All children with head injuries (n = 43) transported to tertiary care [11 by untrained escorts (UE), 32 by trained escorts (TE)] were enrolled. Severity of injury was classified by Glasgow Coma Score (GCS); incidence of adverse events was counted and cost of change of severity resulting from preventable insults was estimated using published care costs.

Results: There were 13 preventable insults in six patients (55%) in the UE group and five preventable insults in four patients (12%) in the TE group (p<0.05). Among those in the UE group, two changed in severity from moderate to severe, one moderate worsened (decrease in GCS of 2 or more), and two severe worsened. In the TE group, there were no changes >1. Cost-benefit estimates based on change in severity were $136,000 (median) to $238,000 (mean).

Conclusion: Significant cost-benefit likely accrues from training escorts who transport children with significant head injuries to tertiary care.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Canada
  • Child
  • Child, Preschool
  • Cost-Benefit Analysis*
  • Craniocerebral Trauma / complications
  • Craniocerebral Trauma / physiopathology
  • Craniocerebral Trauma / therapy*
  • Emergency Medical Technicians / economics*
  • Emergency Medical Technicians / standards
  • Glasgow Coma Scale
  • Humans
  • Infant
  • Inservice Training
  • Patient Care Team / economics*
  • Retrospective Studies
  • Transportation of Patients / economics*