07/21/2021 The Right Care Via the Right Way Shaun C. Ramsey, DO, FACEP, EMT 1 The Right Care Via the Right Way ALS, BLS, and Helicopter EMS in Rural Trauma Shaun C. Ramsey, DO, FACEP, EMT Trauma Medical Director, Munson Cadillac & Grayling Medical Director, North Central MCA Medical Director, Mobile Medical Response MCEP SUMMER ASSEMBLY – JULY 21, 2021 No Financial Disclosures
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07/21/2021
The Right Care Via the Right Way Shaun C. Ramsey, DO, FACEP, EMT 1
The Right Care Via the Right WayALS, BLS, and Helicopter EMS in Rural Trauma
Shaun C. Ramsey, DO, FACEP, EMT
Trauma Medical Director, Munson Cadillac & Grayling
Medical Director, North Central MCA
Medical Director, Mobile Medical Response
MCEP SUMMER ASSEMBLY – JULY 21, 2021
No Financial Disclosures
07/21/2021
The Right Care Via the Right Way Shaun C. Ramsey, DO, FACEP, EMT 2
Objectives
Discuss differences in outcomes of trauma patients treated with advanced life support (ALS) or basic life support (BLS) in the prehospital setting.
Identify when helicopter EMS transport is indicated in rural trauma.
Examine EMS protocols
that activate helicopter EMS
early in the rural trauma setting
Rural Trauma
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Rural Trauma
Mortality higher in rural setting Newgard et al. JAMA Surgery 2017
– 7 counties in Washington & Oregon– 53,000 patients– 29.4% of rural patients transported directly to
major trauma center• 88.7% urban patients
– Most high risk trauma patients were cared for outside of trauma centers
– Rural mortality highest within 24 hours
Rural Trauma
Jarman et al. JAMA Surgery, 2018– Maryland
– Geocoded incident location in relation to trauma center
– Odds of death highest for:• Patients in communities with higher median age or
lower income
• Locations farthest from level 1 or 2 trauma centers
– Odds of death increased 8% for every 5 miles from trauma center
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Rural Trauma
Mortality higher in rural areas– Farther from definitive care
– Must give the best possible care to these pts
– ALS or BLS?
ALS vs. BLS
Liberman Journal of Trauma 2000– Metanalysis – 174 articles
– No benefit to ALS
Many of these urban settings
“Scoop & Run”
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The Right Care Via the Right Way Shaun C. Ramsey, DO, FACEP, EMT 11
Helicopter EMS
Auto Launch– Region 7/North Flight Aero Med
– Launch helicopter based on dispatch info
– >30 min ground transport time to trauma center
Helicopter EMS
Auto Launch Criteria– Area inaccessible by ground– Multiple trauma victims (MCI)– Major MVA, rollover, ejection or entrapment,
death in same vehicle– Pedestrian struck with serious injury– Major burns– Drowning– Penetrating trauma– Falls > 20 ft with serious injury (>10 ft peds)
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Helicopter EMS
Launches HEMS team early
Can rendezvous at helipad
Can assist in emergency department
Summary
Penetrating trauma– BLS has better outcomes than ALS
Blunt trauma– Majority of patients: no benefit to ALS
– Critically injured patients: benefit from HEMS
– Need more rural studies!
Helicopter EMS– Vital to rural trauma
– Consider Auto Launch protocol
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Newgard et al. Evaluation of Rural vs Urban Trauma Patients Served by 9-1-1 Emergency Medical Services, JAMA Surg. 2017;152(1):11-18.
Jarman et al. Associations of Distance to Trauma Care, Community Income, and Neighborhood Median Age With Rates of Injury Mortality, JAMA Surg. 2018;153(6):535-543.
Harmson et al. The influence of prehospital time on trauma patients outcome: A systematic review, Injury, Int. J. Care Injured 46 (2015) 602–609.
Liberman et al. Advanced or Basic Life Support for Trauma: Meta-analysis and Critical Review of the Literature, J Trauma. 2000;49:584–599.
Eisen et al. Advanced Life Support vs Basic Life Support Field Care: An Outcome Study, ACADEMIC EMERGENCY MEDICINE 1998; 5:592-598.
Liberman et al. Multicenter Canadian Study of Prehospital Trauma Care, ANNALS OF SURGERY 2003; 237(2): 153–160.
Isenberg D & Bissell R. Does Advanced Life Support Provide Benefits to Patients?: A Literature Review, Prehosp Disast Med 2005;20(4):265-270.
Stiell et al. The OPALS Major Trauma Study: impact of advanced life support on survival and morbidity, CMAJ 2008;178(9):1141-52.
Cobas et al. Prehospital Intubations and Mortality: A Level 1 Trauma Center Perspective, Anesth Analg 2009;109:489 –93.
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References
Ryynänen et al.: Is advanced life support better than basic life support in prehospital care? A systematic review. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2010 18:62.
Bakalos et al. Advanced life support versus basic life support in the pre-hospital setting: A meta-analysis, Resuscitation 82 (2011) 1130– 1137.
Haut et al. Prehospital Intravenous Fluid Administration Is Associated With Higher Mortality in Trauma Patients: A National Trauma Data Bank Analysis, Ann Surg 2011;253:371–378.
Seamon et al. Prehospital interventions for penetrating trauma victims: A prospective comparison between Advanced Life Support and Basic Life Support, Injury, Int. J. Care Injured 44 (2013) 634–638.
Wandling et al. Police transport versus ground EMS: A trauma system-level evaluation of prehospital care policies and their effect on clinical outcomes, J Trauma Acute Care Surg. 2016;81: 931–935.
Brown et al. External validation of the Air Medical Prehospital Triage score for identifying trauma patients likely to benefit from scene helicopter transport, J Trauma Acute Care Surg. 2017;82: 270–279.
Chen et al. Speed is not everything: Identifying patients who may benefit from helicopter transport despite faster ground transport, J Trauma Acute Care Surg. 2018;84: 549–557.
Michaels et al. Helicopter versus ground ambulance: review of national database for outcomes in survival in transferred trauma patients in the USA, Trauma Surg Acute Care Open 2019;4:e000211.