Evaluation of Air Medical Transport of Trauma Patients in Kansas

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Evaluation of Air Medical Transport of Trauma Patients in Kansas Paul Harrison, MD GM Berg1,2; M Simmons3; D Clark1; D Spaeth1 ; S Pauly2; L Thompson2; RE Crowe2 1Wesley Medical Center; 2KU School of Medicine-Wichita; 3EagleMed Air Transport Kansas Chapter of American College of Surgeons - September 12, 2010

Air Medical Transport in Kansas Recognized for speed and efficiency Benefits rural communities unable to sacrifice ground transport Provides necessary ALS services Kansas 98/105 counties are rural Patients may travel up to 3 hours for trauma care Purpose Pilot evaluation of air medical transport in Kansas

Methods Retrospective chart review (1/1/07 to 12/31/08) EagleMed Wesley Medical Center Trauma Services Hierarchical (exclusive) stratification Glasgow Coma Scale Vital sign data Anatomy of injury Risk by age ALS requirement for transport Specialist needed Patient loaded miles and travel time ED dismissals Glasgow Coma Scale = 13 or less Vital Sign Adult: Systolic BP <90mmHG; Respiratory Rate <10 or >29 Pediatric (age 0-2): Systolic BP <70mmHg; Respiratory Rate <15 or >40; Heart Rate <80 or >180 Pediatric (age 3-5): Systolic BP <80mmHg; Respiratory Rate <10 or >30; Heart Rate <60 or >170 Pediatric (age 6-16): Systolic PB <90mmHg; Respiratory Rate <10 or >25; Heart Rate <60 or >160 Age Risk Adult: 56 or older Pediatric: 4 or less ALS Requirement Patient needed ALS services; ground transport only BLS credentialed Patient loaded miles = based on air transport miles; not equivalent with ground transport mileage Patient travel time in minutes ED dismissals: hierarchical categorization evaluation

Demographics Demographic All (N=483) Adult (n=409) Pediatric (n=74) Male (f, %) 305(63.1) 266(65.0) 39(52.7) Age (mean, SD) 39.7(22.9) 45.1(20.6) 10.9(5.4) White (f, %) 422(87.4) 359(87.8) 63(85.1) Clinical Characteristic ISS (mean, SD) 16.9(16.2) 17.4(16.9) 14.3(11.5) GCS (mean, SD) 11.7(5.1) 11.6(5.1) 11.9(5.1) Trauma Level 1 (f,%) 158(38.6) 133(32.5) 25(33.8) Injury Characteristic Blunt (f, %) 450(93.6) 381(93.6) 69(93.2) MVA (f, %) Fall (f, %) 218(45.1) 106(21.9) 190(46.4) 92(22.5) 28(37.8) 14(18.9) Outcomes Mortality 50(10.4) 43(10.5) 7(9.5)

Adult – Medical Necessity Category (Exclusive) Frequency (%) N=246 Medically Necessary (Urgent) GCS (<14) Vital Sign (BP or RR) Anatomy of Injury 124 (50.4) 19(7.7) 15(6.1) Medically Necessary (Risk) Age >55 22(8.9) Medically Necessary/Non-urgent ALS Required for Transport 39(15.9) Specialist or Tx Needed/Non-urgent 27(11.0) Missing incoming vital sign data 163 of 409 (39.9) Glasgow Coma Scale = 13 or less Adult Vital Sign: Systolic BP <90mmHG; Respiratory Rate <10 or >29 Age Risk: 56 or older

Pediatric – Medical Necessity Category (Exclusive) Frequency (%) N=37 Medically Necessary (Urgent) GCS (<14) Vital Sign (BB, RR, Pulse) Anatomy of Injury 20(54.1) 3(8.1) Medically Necessary (Risk) Age <5 1(2.7) Medically Necessary/Non-urgent ALS Required for Transport 7(18.9) Specialist or Tx Needed/Non-urgent Missing incoming vital sign data 37 of 74 (50.0) Glasgow Coma Scale = 13 or less Vital Sign Pediatric (age 0-2): Systolic BP <70mmHg; Respiratory Rate <15 or >40; Heart Rate <80 or >180 Pediatric (age 3-5): Systolic BP <80mmHg; Respiratory Rate <10 or >30; Heart Rate <60 or >170 Pediatric (age 6-16): Systolic PB <90mmHg; Respiratory Rate <10 or >25; Heart Rate <60 or >160 Age Risk: 4 or less

Travel Time and Distance Travel time in minutes (mean, SD) Hour Categories (Frequency, %) 60 min or less Greater than 60 minutes 42.5(16.7) 426(88.2) 54(11.2) Distance Loaded patient nautical miles (mean, SD) Mile Categories (Frequency, %) 9 - 100 101 - 200 201 - 274 110.53 (52.8) 239(49.5) 185(38.3) 36(7.5) Air speed is dependent on many factors including wind conditions, cargo weight, type of aircraft, and others.

ED Dismissals Pediatric (n=2) MOI ISS MILES GCS VITALs INJ AGE ALS TX 13, Male Fall 4 89 15 -- N Y 14, Female MVA 6 Adult (n=10) 17, Female 3 95 18, Male 1 19, Male 2 82 23, Male 5 100 26, Male 102 14 32, Male Mach 139 49, Male 71 65, Male 54 82, Male 106 86, Male 17 Evaluated the ED dismissals individually: Of the 12: 0 qualified by GCS 0 qualified by vital sign data (3 missing) 1 qualified by anatomy of injury 3 adults qualified by age risk (>55) 6 required air transport due to need for ALS services and ground only BLS certified All required higher level of treatment or specialist as determined by sending physician....but does this necessitate air transport? CODING: VITALs N = did not qualify by vital signs (BP, RR, HR) = missing vital sign data AGE: Pediatric N = not under age 5 Adult N = not over age 55 Adult Y = over age 55 ALS Y = did require ALS transport N = did NOT require ALS transport TX (Treatment or specialist needed) Y = sending physician recommended specialist/specialist treatment N = did not recommend specialist/specialist treatment Miles are patient loaded miles