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- Fredriksson Sundbom, Marcus, et al.
(författare)
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Total Mission Time and Mortality in a Regional Interhospital Critical Care Transport System : A Retrospective Observational Study
- 2021
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Ingår i: Air Medical Journal. - : Elsevier. - 1067-991X .- 1532-6497. ; 40:6, s. 404-409
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Tidskriftsartikel (refereegranskat)abstract
- Objective: We assessed the mortality risk related to the time for intensive care unit transport in a geographically large regional health care system.Methods: Patient-level data from critical care ambulance missions were analyzed for 2,067 cases, mission time, and relevant patient factors. Mission time was used as a surrogate for the “distance” to tertiary care, and mortality at 7 days and other intervals was assessed.Results: No increased mortality risk was found at 7 days in an unadjusted regression analysis (odds ratio = 1.00; range, 0.999-1.002; P = .66). In a secondary analysis, an increased mortality risk was observed in longer mission time subgroups and at later mortality assessment intervals (> 375 mission minutes and 90-day mortality; adjusted hazard ratio = 1.56; range, 1.07-2.28; P = .02). Negative changes in oxygenation and hemodynamic status and transport-related adverse events were associated with the longest flight times. Measurable but small changes during flight were noted for mean arterial pressure and oxygenation.Conclusion: The main finding was that there was no overall difference in mortality risk based on mission time. We conclude that transport distances or accessibility to critical care in the tertiary care center in a geographically large but sparsely populated region is not clearly associated with mortality risk.
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- Stassen, Willem, et al.
(författare)
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A Retrospective Geospatial Simulation Study of Helicopter Emergency Medical Services' Potential Time Benefit Over Ground Ambulance Transport in Northern South Africa.
- 2023
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Ingår i: Air Medical Journal. - : Elsevier. - 1067-991X .- 1532-6497. ; 42:6, s. 440-444
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: One of the most important benefits of helicopter emergency medical services (HEMS) is a time benefit, either through expedited access to the casualty or a reduction in the transport time to definitive care. However, HEMS utilization does not come without risk to the public and crew or at an insignificant cost. Cost is an essential consideration for health policy decisions, especially in low- to middle-income countries, such as South Africa. The aim of this study was to determine whether there is a time benefit of HEMS dispatch in South Africa compared with simulated driving time. A secondary aim was to determine the distance from the incident site to the hospital at which a time benefit can be guaranteed.METHODS: A retrospective study was undertaken by comparing the prehospital times of patients who underwent HEMS transportation with simulated ground emergency medical services (GEMS) transportation times. Handwritten patient records of actual flights were reviewed and analyzed. The actual flight times recorded were used to calculate the helicopter transport time, activation to scene time, scene time, and scene to hospital time. Times were assigned based on a nonsimultaneous dispatch model, as is used in South Africa. For each helicopter mission, Google Maps (Google Inc, Mountain View, CA) was used to simulate the fastest ground route from the same location of the incident to the same receiving hospital corrected for typical traffic trends. The actual HEMS and simulated GEMS times were compared using the paired t-test. Linear regression analysis was performed to determine a minimum driving distance at which HEMS provides a time benefit.RESULTS: A total of 118 HEMS transports were analyzed, the majority of which were trauma related (n = 115, 97%). HEMS transport resulted in a mean time deficit of -15 minutes (95% confidence interval, -18 to -11; P < .05) compared with simulated GEMS drive times. After regression, HEMS transport provides a time benefit at a driving distance greater than 119 km.CONCLUSION: The current study demonstrated that there was rarely a time benefit for actual primary emergency responses when HEMS was used compared with simulated driving time of GEMS transport. Using a nonsimultaneous dispatch model, a time benefit only occurs when the driving distance from the incident site to the hospital is greater than 119 km. There is an urgent need to critically evaluate HEMS utilization in the South African context.
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- Stassen, Willem, et al.
(författare)
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Helicopter Emergency Medical Services in Trauma Does Not Influence Mortality in South Africa
- 2020
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Ingår i: Air Medical Journal. - : Elsevier. - 1067-991X .- 1532-6497. ; 39:6, s. 479-483
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Sub-Saharan Africa carries a large trauma burden. Helicopter emergency medical services (HEMS) have been suggested to reduce prehospital time and mortality. It is not clear whether HEMS infers a mortality benefit over ground transport in South Africa. This study aimed to determine whether HEMS improved 30-day mortality over ground emergency medical services (GEMS).METHODS: A retrospective, case-control study was undertaken for major trauma patients transported to a private trauma center in Johannesburg. A 1-year cohort of HEMS patients was extracted and matched to GEMS patients based on mechanism, injury severity or percentage of the total body surface area burned, age, sex, and comorbidities. The odds ratio (OR) for 30-day mortality was calculated to determine the risk of death.RESULTS: A total of 822 cases (HEMS: 272 [33%], GEMS: 550 [67%]) were reviewed. We included 410 patients in the matched cohort with equal distribution between transportation modes. The OR for mortality in the total cohort was 2.69 (95% confidence interval, 1.6-4.6; P = .003) for HEMS patients, whereas in the matched cohort the OR was 1.35 (95% confidence interval, 0.5-3.4; P = .503) for patients transported by HEMS.CONCLUSION: In a matched cohort of major trauma patients, HEMS does not seem to improve mortality over GEMS. These results might reflect the South African HEMS dispatch model.
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- Liebenhagen, Andreas
(författare)
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Development and Psychometric Exploration of the Anesthesia Surrendering Instrument (ASI)
- 2019
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Ingår i: Journal of Perianesthesia Nursing. - : Elsevier BV. - 1532-8473 .- 1089-9472. ; 34:1, s. 169-179
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Tidskriftsartikel (refereegranskat)abstract
- PurposeThe aim of this study was to develop and test an instrument to measure surrendering at the time of anesthesia induction and to explore the construct validity.DesignAn instrumental cross-sectional design was used and construct validity was evaluated via psychometric testing.MethodsThe anesthesia surrendering instrument (ASI) comprised 36 items. A total of 202 adults (older than 18 years) answered the questionnaire. Principal component analysis was used for item reduction and identification of defining constructs.FindingsSurrendering to anesthesia was defined by four constructs: preparation by avoidance, control, preparation by understanding, and acceptance, explaining 43.2% of the variance in the matrix.ConclusionsThe findings show that it is possible to measure the concept of surrendering by means of four dimensions as preparation by avoidance, control, preparation by understanding, and acceptance, although the dimensional variance of 43% could be considered weak. The ASI will constitute context-specific patient-reported experience measures for anesthesia, whereas further item refinement and testing of the ASI are necessary to achieve a better variance.
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