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Physician-provided prehospital critical care, effect on patient physiology dynamics and on-scene time

Reid, Bjørn O.a; Rehn, Mariusb,c,d; Uleberg, Oddvara; Krüger, Andreas J.a,b

European Journal of Emergency Medicine: April 2018 - Volume 25 - Issue 2 - p 114–119
doi: 10.1097/MEJ.0000000000000432
ORIGINAL ARTICLES
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Introduction Improved physiologic status can be seen as a surrogate measure of improved outcome and a field-friendly prognostic model such as the Mainz Emergency Evaluation Score (MEES) could quantify the effect on physiological response. We aim to examine the dynamic physiological profile as measured by this score on patients managed by physician-manned helicopter emergency medical services and how this profile was related to on-scene time expenditure and critical care interventions.

Materials and methods Data including patient characteristics, physiological data, and description of diagnostic and therapeutic interventions were prospectively collected over two 14-day periods, summer and winter, at six participating Norwegian bases. The MEES score was utilized to examine the difference between a score measured at first patient contact (MEES 1) and end-of-care (MEES 2), (MEES 2–MEES 1=[INCREMENT]MEES).

Results A total of 240 primary missions with patient-on-scene form the basis of the study. In total, 43% were considered severely ill or injured, of whom 59% were medical patients. Twenty-nine percent were severely deranged physiologically. The most common advanced procedure performed was advanced airway management (15%), followed by defibrillation (8.8%). Using [INCREMENT]MEES as an indicator, 1% deteriorated under care, whereas 66% remained unchanged and 33% showed an improvement in their physiological status. With increasing on-scene time, fewer patients deteriorated and a greater proportion of patients improved.

Conclusion Restoring deranged physiology remains a mantra for all critical care practitioners. We have shown that this is also possible in the prehospital context, even when prolonging on-scene time, and after initiating advanced procedures.

aDepartment of Emergency Medicine and Prehospital Services, St Olavs Hospital, Trondheim

bDepartment of Research and Development, Norwegian Air Ambulance Foundation, Drøbak

cDepartment of Health Studies, University of Stavanger, Stavanger

dDepartment of Anaesthesia, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway

Correspondence to Bjørn O. Reid, MD, Department of Emergency Medicine and Prehospital Services, Prinsesse Kristinas Gate 3, AHL, St Olavs University Hospital, 7030 Trondheim, Norway Tel: +47 404 88893; fax: +47 72505039; e-mail: bjorn.ole.reid@stolav.no

Received May 4, 2016

Accepted October 17, 2016

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