Addition of physicians to paramedic helicopter services decreases blunt trauma mortality

Background: The authors hypothesized that the addition of critical care phy sicians to the flight crew of paramedic helicopter services would decrease mortality in blunt trauma, and that this would be due to the greater proced ural capability and clinical judgement of the physician. Methods: Retrospective comparison was undertaken of patients flown directly from the accident scene over a 28-month period by the paramedic-staffed We stpac Hunter region helicopter to John Hunter Hospital. and the physician-s taffed NRMA CareFlight helicopter to Westmead or Nepean Hospitals. Inclusio n criteria were blunt trauma and an Injury Severity Score of greater than o r equal to 10, Mortality was compared by trauma score-injury severity score (TRISS) methodology. Results: There were 140 patients in the paramedic treatment group and 67 in the physician group. There were no significant differences between the gro ups in age, mechanism of injury, distance transported, response, scene or t ransport times. Physicians intubated a greater proportion of patients (51 v s 10%; P < 0.001) including all patients with a Glasgow Coma Score of < 9. Physicians gave significantly greater Volumes of fluids to hypotensive pati ents (median: 5035 vs 1475 mt; P < 0.001) and performed thoracic decompress ions on a larger proportion of patients (12 vs 1%; P < 0.01). The Z statist ic for the physician treatment group was 2.72 (P < 0.01) compared with -1.1 6 (P = 0.25) in the paramedic group. The adjusted W statistic was 13.44 (95 % CI: 7.80-19.08) suggesting that there would be between eight and 19 extra survivors per 100 patients treated in the physician group compared with th e paramedic group. Conclusions: Physicians perform a greater number of procedures at accident scenes without increasing scene time. This results in significantly lower m ortality. Critical care physicians should be added to paramedic helicopter services for scene response to blunt trauma.