Ejection as a key word for the dispatch of a physician staffed helicopter:the Swiss experience

We evaluated the type and severity of injuries and the possible influence o f a helicopter staffed by a physician on the outcome of 71 consecutive occu pants ejected from a four-wheel vehicle ejected occupants who were cared fo r by the Swiss Air Rescue Helicopter team from January 1994 to February 199 9. The investigation and the data collection were planned prospectively. Th e following data were collected for each patient ejected from a four wheel vehicle: (1) demographic information; (2) type of injury (3) vital signs on scene, in flight and at hospital; (4) hospital diagnosis; (5) injury sever ity score; (6) secondary transfer; (7) length of stay in hospital and on in tensive care; and (8) outcome at hospital discharge. A control group includ ed consecutive patients cared for by the same rescue team during the same p eriod but who were not ejected out of their vehicle. Forty-four percent of the ejected patients had a GCS less than or equal to 8, 21% were hypotensiv e and 22% had respiratory problems. Nine patients died at the scene. A tota l of 53% of the 62 ejected patients who were transported had an ISS greater than or equal to 16. The median ISS was 17. A total of 37% of the patients were intubated at the scene, needle chest decompression was performed in 5 % and major analgesia was used in 27% of the cases. A total of 38% of the p atients needed surgery in the first 4 h, 34% needed intensive care. No pati ent needed secondary transfer to the Trauma Centre if they were not brought there in the first instance. The outcome was poor in 27 cases (38%): 17 di ed and 10 needed transfer to specialised institutions. Non-ejected patients suffered mostly from head and neck injuries (50%) of which 9% were severe (head and neck AIS greater than or equal to 4, P < 0.05). Thoracic injuries were less frequent (35%) of which 13% were severe (thorax AIS <greater tha n or equal to> 4, P < 0,05). The median ISS was 9 for the non-ejected patie nts, P < 0.05. In conclusion, ejection from a four-wheel vehicle causes mor e severe injuries and requires a high number of advanced life support manoe uvres. Based on the mechanism of injury alone, patients ejected from four-w heel Vehicles should automatically receive a response from the best availab le pre-hospital team. In our system, this means the dispatch of a physician staffed helicopter. (C) 2001 Elsevier Science Ireland Ltd. All rights rese rved.