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.
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).
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.
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: firstname.lastname@example.org
Received May 4, 2016
Accepted October 17, 2016