University of Hertfordshire

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  • Sameer Pathan
  • Jason Soulek
  • Isma Qureshi
  • Howard Werman
  • Andrew Reimer
  • Michael W. Brunko
  • Guillaume Alinier
  • Furqan B. Irfan
  • Stephen Hodges Thomas
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Original languageEnglish
Article number8
Pages (from-to)1-16
JournalJournal of Emergency Medicine, Trauma, and Acute Care
Journal publication date19 Sep 2017
Early online date19 Sep 2017
DOIs
Publication statusE-pub ahead of print - 19 Sep 2017

Abstract

Background: Helicopter emergency medical services (HEMS) and ground EMS (GEMS) are both integral parts of out-of-hospital transport systems for patients with ST-elevation myocardial infarction (STEMI) undergoing emergency transport for primary percutaneous coronary intervention (PPCI). There are firm data linking time savings for PPCI transports with improved outcome. A previous pilot analysis generated preliminary estimates for potential HEMS-associated time savings for PPCI transports.
Methods: This non-interventional multicenter study conducted over the period 2012–2014 at six centers in the USA and in the State of Qatar assessed a consecutive series of HEMS transports for PPCI; at one center, consecutive GEMS transports of at least 15 miles were also assessed if they came from sites that also used HEMS (dual-mode referring hospitals). The study assessed time from ground or air EMS dispatch to transport a patient to a cardiac center, through to the time of patient arrival at the receiving cardiac unit, to determine proportions of patients arriving within accepted 90- and 120-minute time windows for PPCI. Actual times were compared to “route-mapping” GEMS times generated using geographical information software. HEMS’ potential time savings were calculated
using program-specific aircraft characteristics, and the potential time savings for HEMS was translated into estimated mortality benefit.
Results: The study included 257 HEMS and 27 GEMS cases. HEMS cases had a high rate of overall transport time (from dispatch to receiving cardiac unit arrival) that fell within the predefined windows of 90 minutes (67.7% of HEMS cases) and 120 minutes (91.1% of HEMS cases). As compared to the
calculated GEMS times, HEMS was estimated to accrue a median time saving of 32 minutes (interquartile range, 17–46). The number needed to transport for HEMS to get one additional case to PPCI within 90 minutes was 3. In the varied contexts of this multicenter study, the number of lives saved by HEMS, solely through time savings, was calculated as 1.34 per 100 HEMS PPCI transports.
Conclusions: In this multicenter study, HEMS PPCI transport was found to be appropriate as defined by meeting predefined time windows. The overall estimate for lives saved through time savings alone was consistent with previous pilot data and was also generally consistent with favorable cost-effectiveness.
Further research is necessary to confirm these findings, but judicious HEMS deployment for PPCI transports is justified by these data.

Notes

This is an open access article distributed under the terms of the Creative Commons Attribution license CC BY 4.0, which permits unrestricted use, distribution and reproduction in any medium, provided the original work is properly cited. ©2017 The Author(s), licensee HBKU Press.

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