HEMS vs. Ground-BLS care in traumatic cardiac arrest

Prehosp Emerg Care. Jan-Mar 2005;9(1):79-84. doi: 10.1080/10903120590891886.

Abstract

Objective: To assess whether a top-level type of prehospital care, made of helicopter, physician, and advanced life support (ALS) procedures, improves the outcome of blunt trauma victims found in cardiac arrest (CA) as compared with a simpler type, composed of ground ambulance, nurse, and expanded basic life support (BLS).

Methods: This was a cohort study from the data set of a prospective, population-based, 12-month study targeting the 1,200,000 inhabitants of the Italian region Friuli Venezia Giulia.

Results: Fifty-six victims received the higher level of care (helicopter emergency medical services [HEMS] group) and 73 received the lower one (ground-BLS group). The two groups were homogeneous for mechanism of injury, gender, and time interval before cardiopulmonary resuscitation (CPR). Age was lower in the ground-BLS group. The percentage of patients in which CPR was attempted was significantly higher in the HEMS group (43% vs. 20%; CI 0.061 to 0.379). On-scene return of spontaneous circulation (ROSC) was also more likely in the HEMS group (37.5% of attempted CPRs vs. 6.6%; CI 0.027 to 0.591). None of the patients evacuated from the scene without ROSC ever attained it in hospital. This policy was virtually exclusive to the ground-BLS group. Survival to hospital discharge was 3.5% (severely disabled) in the HEMS group and 0% in the ground-BLS group (CI -0.008 to 0.078).

Conclusion: A top-level type of prehospital care had significantly more chances to resuscitate blunt trauma victims found in CA as compared with a simpler level. No significant benefit on long-term outcome was found, but more cases might be needed in future studies because of the inevitably low number of survivors.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Air Ambulances*
  • Ambulances*
  • Cardiopulmonary Resuscitation / methods*
  • Cardiopulmonary Resuscitation / mortality
  • Cohort Studies
  • Confidence Intervals
  • Emergency Medical Services / methods*
  • Female
  • Follow-Up Studies
  • Heart Arrest / etiology
  • Heart Arrest / mortality*
  • Heart Arrest / therapy*
  • Humans
  • Italy
  • Life Support Care / methods
  • Male
  • Middle Aged
  • Probability
  • Prospective Studies
  • Risk Assessment
  • Survival Rate
  • Treatment Outcome
  • Wounds, Nonpenetrating / complications