Nicholas H. Benson

Helicopter use by rural emergency departments to transfer trauma victims: A study of time-to-request intervals

To assess how soon rural emergency departments (EDs) call for helicopters to transport seriously injured patients, the records of all trauma victims (excluding isolated CNS trauma) transported by an emergency helicopter service from referring hospitals to a trauma center over an 18-month period were studied. Admission time to the referring ED was compared with the exact time a call for the helicopter was received and a time-to-request interval (TTR) was calculated. A total of 64 cases were studied. Fifty (78%) of the patients had blunt trauma; 14 (22%) had penetrating trauma. The average TTR for the helicopter was 69.8 minutes, with a range from 17 minutes before arrival at the referring ED to 337 minutes after arrival. Children (aged less than or equal to 16 years) had an average TTR of 34.1 minutes compared with 76.4 minutes for adults (aged greater than 16 years). Of the variables examined, patient age was the only factor significantly associated with TTR. These observations suggest that, except in children, there frequently is a lengthy time interval between the time trauma patients arrive at EDs in rural eastern North Carolina and the time an emergency helicopter service is called to transport them to a trauma center.

A comparison of four methods of testing emergency medical technician triage skills

Triage skills are requisite for all providers of prehospital care. Methods of assessing the acquisition of triage skills vary in complexity and expense. In this study, 61 prehospital care providers classified 20 cases, divided into four groups of five cases each: moulaged live trauma victims, nonmoulaged live trauma victims, nonmoulaged manikin trauma victims, and written scenarios. The providers were asked to classify the cases in each group by assigning triage tags to indicate injury severity and to rank the trauma victims in each group according to the urgency of care required. Analysis of variance revealed statistically significant differences among the four methods in both mean tagging scores (F3,235 = 8.63, P less than .0001) and mean ranking scores (F3,232 = 6.09, P less than .001). Multiple comparisons using Scheffes test revealed that the mean tagging and ranking scores for moulaged live victims and written scenario methods were comparable and that both were significantly superior to the scores of the two other methods. However, a qualitative evaluation revealed that the providers greatly preferred triage of moulaged live victims to the other three methods.

Stress, depression and job satisfaction

Abstract Recent crashes of aeromedical aircraft have focused attention on the occupational stress experienced by aeromedical personnel. A mail survey of six hospital-based aeromedical transport services was conducted to investigate the occupational satisfaction and stress perceived by flight personnel. The survey questionnaire included a stress inventory, a depression scale and a job satisfaction scale. Respondents included nurses, emergency medical technicians, respiratory therapists and pilots. The expected relationships between stress and depression (r = 46, p

Influence of demographic variables in prehospital treatment of patients with chest pain

OBJECTIVE To determine whether the number of interventions requested by EMS personnel for patients with acute, nontraumatic chest pain varied with the patients gender or race. METHODS The authors conducted a retrospective chart review of the care requested for patients 17 years old or older complaining of acute, nontraumatic chest pain by one EMS squad in a city of 50,000 people over a six-month period. Interventions recorded for each patient included oxygen administration, artificial airway placement, intravenous fluid administration, defibrillation, and use of lidocaine and nitroglycerin. RESULTS Of the 169 patients in this study, 54% (n = 92) were white and 56% (n = 95) were female. Age was missing for two patients; of the remainder, 75% (n = 127) were 40 years old or older. The numbers of interventions requested ranged from 0 to 4. EMS personnel requested supplemental oxygen for 163 patients. 81% of the females had i.v. lines placed or attempted, compared with 70% of the males; EMS personnel requested orders for nitroglycerin for 43% of the females and 29% of the males. Whites were more likely than nonwhites to have requests for i.v. lines or nitroglycerin. Overall, the numbers of interventions were similar among young females and among older patients, regardless of race or gender. The pattern for young males was different, with significantly more requests for interventions for young white males than for young non-white males (1.89 vs 1.34). CONCLUSIONS Among older patients and among young females, EMS personnel requested similar numbers of interventions for patient complaining of acute, nontraumatic chest pain regardless of patients race. Patterns of care appeared to differ for young males, a finding that warrants further study.

Prototype Curriculum for a Fellowship in Emergency Medical Services

The developments of emergency medicine and emergency medical services (EMS) have occurred simultaneously although at times on parallel paths. The recognition of EMS providers as physician surrogates and emergency care resources as an extension of emergency department care has mandated close physician involvement. This intimate physician involvement in EMS activities is now well accepted. It has, however, pointed out the need for in-depth training of physicians in the subspecialty of EMS.

Improved flight following through continuous quality improvement

INTRODUCTION Flight following is a key component of an air medical transport services safety program. National standards require conscientious adherence to flight following. EastCare monitored its compliance with internal flight-following requirements for three years. SETTING EastCare is a single-helicopter, hospital-based air medical transport service located in a rural region of the southeastern United States. It has a full-time staff of flight nurses, pilots and communications specialists. METHODS A continuous quality improvement (CQI) process was initiated to delineate specific areas requiring improvement. These areas were discussed at the air medical services monthly CQI meetings. RESULTS In 1989, the communications specialists achieved flight following intervals of < or = 15 minutes in 98% of attempts. In 1990 and 1991, the frequency of flight-following intervals of < or = 15 minutes were 98.8% and 99.6%, respectively. The CQI process pointed out educational requirements, technological problems and other areas for improvement. CONCLUSION The use of a structured CQI process for this service directly contributed to consistently strong compliance in the frequency of flight following.

Occupational stress and job satisfaction among flight nurses. A survey of National Flight Nurses Association members.

A mail survey of members of the National Flight Nurses Association was conducted to assess occupational stress and job satisfaction. In addition to scales measuring stress and job satisfaction, the questionnaire requested demographic information and included a depression scale. The anticipated direct relationship between stress and depression was observed (r = .56, p .0001), as were the expected inverse relationships between stress and job satisfaction (r = .54, p less than .0001), and between depression and job satisfaction (r = -.45, p .0001). Responses to statements on the stress scale indicated that work interference with family life and failure to receive recognition were important sources of stress, while avoidance behaviors such as tardiness and daydreaming were used infrequently to cope with stress. Inadequate recognition, particularly by administrators and supervisors, and lack of involvement in decision-making processes surfaced as sources of dissatisfaction, as did inadequate feedback about job performance. The tasks performed by flight nurses and being members of cohesive work groups were important sources of job satisfaction. The results indicate that although flight nurses basically are satisfied with their jobs and enjoy working in air medical transport, they want to know that they are performing well. They also want to be involved in decision-making processes and to be recognized for the stressful jobs they perform.

Air medical transport utilization review in North Carolina.

OBJECTIVE To perform a review of the collective experience of all hospital-based helicopter ambulances in the state of North Carolina for compliance with utilization review criteria. DESIGN Flight records of the six members of the North Carolina Aeromedical Affiliation for the months of November and December 1989 were compared with utilization review criteria by an independent reviewer. A secondary review was performed by a staff member for each service. Scene responses and patients flown to a hospital other than the sponsor were evaluated. SETTING All six hospital-based helicopter services in North Carolina. TYPE OF PARTICIPANTS All available flight records for November and December 1989. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Of 756 transports, 747 flight records were available for review. Initial review demonstrated compliance with the criteria for 713 (95.4%) patients; secondary review showed compliance for 18 of 34 flights not meeting initial review, for an overall compliance rate of 97.9%. Compliance rates for scene responses and transports taken to a hospital other than the sponsoring facility were 96.6% and 94.1%, respectively. CONCLUSIONS Review of all flights over a period of two-months by all six hospital-based helicopter services in North Carolina using utilization review criteria demonstrated a very high rate of compliance with the established criteria.

Criteria for Prehospital Air Medical Transport: Nontrauma and Pediatric Considerations Air Medical Services Committee of the National Association of EMS Physicians (NAEMSP)

The proliferation of air medical transport in the 1980s and 1990s has been accompanied by minimal investigation into the appropriateness of transport.1 A strong foundation has been developed regarding adult trauma. 2 However, important issues in pediatric and general medical patients have not been addressed. The health-care crisis in America mandates air medical transport systems to provide appropriate access to medical technology and resources in a cost-effective manner while maintaining quality of care. We must identify the patients whose outcomes will benefit from air medical transport. To make rational decisions regarding air medical transport, we must consider the real benefits of that transport. For both fixed-wing and rotor-wing aircraft, the need for a highly trained critical care team to transport critically ill/injured patients to a center providing an advanced level of care is a well-accepted concept. Reducing out-of-hospital time for these patients seems to be in their best interest. Ground-based prehospital care providers, faced with a patient whose needs obviously exceed their ability, may wish to access a rotor-wing air medical transport service, especially if they are distant from an appropriate medical facility. Geography is of concern in some

Predictors of flight nurse job satisfaction.

A mail survey was conducted to investigate occupational stress, depression, and job satisfaction among flight nurses. Multivariate multiple regression was used to predict job satisfaction and depression simultaneously. Age, gender, marital status, years employed in air medical transport, employment in a hospital-based program, employment in a program which made scene responses, and stress were the independent variables. The multivariate equation (lambda = 0.54, F14,684 = 17.55, p less than 0.0001) and the univariate equations predicting depression (F7,343 = 24.04, p less than 0.0001) and job satisfaction (F7,343 = 24.09, p less than 0.0001) were significant. Stress was a highly significant predictor of both depression (t = 12.48, df = 1, p less than 0.0001) and job satisfaction (t = -12.13, df = 1, p less than 0.0001). Older respondents were more likely to be satisfied with their jobs (t = 1.99, df = 1, p less than 0.05), and respondents who made scene responses were less likely to be satisfied (t = -2.41, df = 1, p less than 0.05). Identification of flight nurses experiencing high levels of stress and interventions to alleviate this stress, utilizing the experience of older flight nurses, and adequate preparation for scene responses may enhance job satisfaction and perhaps reduce attrition.