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Air medical scene response for illness revisited
AN ANALYSIS OF HIGH-RISK MATERNAL PATIENTS DENIED TRANSPORT TO A PERINATAL CENTER
Peggy L. Wagner, Dennis T. Uehara, Thomas A. Losure, John Costelto, REACT, Rockford Memorial Hospital, 2400 N. Rockton Ave, Rockford, IL 61103 Introduction: The b e n e f i t of h i g h - r i s k m a t e r n a l t r a n s p o r t r e l a t i v e t o n e o n a t a l outcome i s w e l l recognized, with maternal-fetal safety during transport remaining a concern. This s t u d y a n a l y z e s m a t e r n a l p a t i e n t s who were d e n i e d t r a n s p o r t due t o m a t e r n a l - f e t a l
risks.
Methods: We reviewed 2 years of request s for maternal transport. Data were analyzed using Chi square and t-testing. Results: 441 requests were reviewed. Of these, 255 were transported by ground, 137 by air, and 49 denied transport. 32 denials were due to tack of beds in the NICU, 14 due to medical risks or other reasons (n=3). Medical denials were due to advanced (~5cm) or rapid cervical dilation (ACD) (n=11), or nonreassuring fetal status (NFS) (n=3). During the study period, there were 12 patients with ACD and 5 with NFS successfully transported. There were no significant differences between transported and denied patient demographics, gestational age, contractions, and parity. Cervical dilation was higher in the denied patients (denied=6cm, transported=2cm, p
422
AIR MEDICAL REVISITED
SCENE
RESPONSE
FOR
IT.I.~ESS
R i t a J o h n s o n a n d R o b e r t E. F a l c o n e , L i f e F l i g h t , G r a n t M e d i c a l C e n t e r , 393 East Town Street, Columbus, Ohio 43215 I~ERODUCTION: P r e v i o u s w o r k in o u r service area suggested that air m e d i c a l t r a n s p o r t f r o m the s c e n e of i l l n e s s is u s u a l l y i n a p p r o p r i a t e . G u i d e l i n e s for the a p p r o p r i a t e u t i l i z a t i o n of a i r m e d i c a l t r a n s p o r t for m e d i c a l s c e n e r e s p o n s e w e r e developed and promulgated using ongoing didactic prehospital courses in the s e r v i c e a r e a a n d local, regional and national publication. This retrospective review describes the s t u d y i n s t i t u t i o n ' s e x p e r i e n c e f o l l o w i n g this a g g r e s s i v e p r e h o s p i t a l educational program. METHODS= R e t r o s p e c t i v e r e v i e w of all p a t i e n t s t r a n s p o r t e d f r o m the s c e n e of i l l n e s s to t e r t i a r y c a r e b y a i r f r o m 7 - 9 1 t h r o u g h 9-93. T e r t i a r y c a r e (3 ° ) w a s d e e m e d n e c e s s a r y if it c o u l d n o t b e p r o v i d e d at the p a t i e n t ' s l o c a l institution. Helicopter transport (HELI) w a s d e e m e d a p p r o p r i a t e if it met previously published criteria. T h e c u r r e n t 27 m o n t h s t u d y p e r i o d (91, 93) w a s c o m p a r e d to the o r i g i n a l 27 m o n t h s t u d y p e r i o d (88-90). RESULTS: I n the 27 m o n t h s e n d i n g 1993, t h e r e w e r e 3 , 6 6 9 c o m p l e t e d missions and 1,039 scene missions. 27 of t h e s e w e r e for i l l n e s s . T h e 27 p a t i e n t s t r a n s p o r t e d for i l l n e s s i n c l u d e d ii m a l e s a n d 16 f e m a l e s . T h e y a v e r a g e d 22.3 y e a r s of age. Time f r o m h e l i c o p t e r d i s p a t c h to t e r t i a r y care averaged 48.6 minutes. Significant differences between'the two s t u d y g r o u p s are p r e s e n t e d b e l o w : 1988-90
1991-93
NOMBER
68/684 27/1039 <0.0001 AGE 39.2 22.3 <0.005 DX: A R R E S T 20/68 6/27 <0.02 DX: S E I Z U R E 1 0 / 6 8 13/27 <0.02 3 ° NEEDED 14/68 19/27 <0.003 HELI NEEDED 0/68 8/27 <0.0002 T o t a l m i s s i o n v o l u m e i n c r e a s e d (3,669 vs 2,414) w h i l e the p e r c e n t s c e n e v o l u m e r e m a i n e d c o n s t a n t (28.3%). CONCLUSION: Inappropriate air medical transport has decreased significantly in o u r s e r v i c e a r e a w i t h o u t a d v e r s e l y a f f e c t i n g v o l u m e m o s t p r o b a b l y as a r e s u l t of a g g r e s s i v e e d u c a t i o n . Inappropriate air medical scene r e s p o n s e for s e i z u r e s c o n t i n u e s to be a problem.
Air Medical Journal
13:10 October 1994
Peggy L. Wagner, Dennis T. Uehara, Thomas A. Losure, John Costelto, REACT, Rockford Memorial Hospital, 2400 N. Rockton Ave, Rockford, IL 61103 Introduction: The b e n e f i t of h i g h - r i s k m a t e r n a l t r a n s p o r t r e l a t i v e t o n e o n a t a l outcome i s w e l l recognized, with maternal-fetal safety during transport remaining a concern. This s t u d y a n a l y z e s m a t e r n a l p a t i e n t s who were d e n i e d t r a n s p o r t due t o m a t e r n a l - f e t a l
risks.
Methods: We reviewed 2 years of request s for maternal transport. Data were analyzed using Chi square and t-testing. Results: 441 requests were reviewed. Of these, 255 were transported by ground, 137 by air, and 49 denied transport. 32 denials were due to tack of beds in the NICU, 14 due to medical risks or other reasons (n=3). Medical denials were due to advanced (~5cm) or rapid cervical dilation (ACD) (n=11), or nonreassuring fetal status (NFS) (n=3). During the study period, there were 12 patients with ACD and 5 with NFS successfully transported. There were no significant differences between transported and denied patient demographics, gestational age, contractions, and parity. Cervical dilation was higher in the denied patients (denied=6cm, transported=2cm, p
422
AIR MEDICAL REVISITED
SCENE
RESPONSE
FOR
IT.I.~ESS
R i t a J o h n s o n a n d R o b e r t E. F a l c o n e , L i f e F l i g h t , G r a n t M e d i c a l C e n t e r , 393 East Town Street, Columbus, Ohio 43215 I~ERODUCTION: P r e v i o u s w o r k in o u r service area suggested that air m e d i c a l t r a n s p o r t f r o m the s c e n e of i l l n e s s is u s u a l l y i n a p p r o p r i a t e . G u i d e l i n e s for the a p p r o p r i a t e u t i l i z a t i o n of a i r m e d i c a l t r a n s p o r t for m e d i c a l s c e n e r e s p o n s e w e r e developed and promulgated using ongoing didactic prehospital courses in the s e r v i c e a r e a a n d local, regional and national publication. This retrospective review describes the s t u d y i n s t i t u t i o n ' s e x p e r i e n c e f o l l o w i n g this a g g r e s s i v e p r e h o s p i t a l educational program. METHODS= R e t r o s p e c t i v e r e v i e w of all p a t i e n t s t r a n s p o r t e d f r o m the s c e n e of i l l n e s s to t e r t i a r y c a r e b y a i r f r o m 7 - 9 1 t h r o u g h 9-93. T e r t i a r y c a r e (3 ° ) w a s d e e m e d n e c e s s a r y if it c o u l d n o t b e p r o v i d e d at the p a t i e n t ' s l o c a l institution. Helicopter transport (HELI) w a s d e e m e d a p p r o p r i a t e if it met previously published criteria. T h e c u r r e n t 27 m o n t h s t u d y p e r i o d (91, 93) w a s c o m p a r e d to the o r i g i n a l 27 m o n t h s t u d y p e r i o d (88-90). RESULTS: I n the 27 m o n t h s e n d i n g 1993, t h e r e w e r e 3 , 6 6 9 c o m p l e t e d missions and 1,039 scene missions. 27 of t h e s e w e r e for i l l n e s s . T h e 27 p a t i e n t s t r a n s p o r t e d for i l l n e s s i n c l u d e d ii m a l e s a n d 16 f e m a l e s . T h e y a v e r a g e d 22.3 y e a r s of age. Time f r o m h e l i c o p t e r d i s p a t c h to t e r t i a r y care averaged 48.6 minutes. Significant differences between'the two s t u d y g r o u p s are p r e s e n t e d b e l o w : 1988-90
1991-93
NOMBER
68/684 27/1039 <0.0001 AGE 39.2 22.3 <0.005 DX: A R R E S T 20/68 6/27 <0.02 DX: S E I Z U R E 1 0 / 6 8 13/27 <0.02 3 ° NEEDED 14/68 19/27 <0.003 HELI NEEDED 0/68 8/27 <0.0002 T o t a l m i s s i o n v o l u m e i n c r e a s e d (3,669 vs 2,414) w h i l e the p e r c e n t s c e n e v o l u m e r e m a i n e d c o n s t a n t (28.3%). CONCLUSION: Inappropriate air medical transport has decreased significantly in o u r s e r v i c e a r e a w i t h o u t a d v e r s e l y a f f e c t i n g v o l u m e m o s t p r o b a b l y as a r e s u l t of a g g r e s s i v e e d u c a t i o n . Inappropriate air medical scene r e s p o n s e for s e i z u r e s c o n t i n u e s to be a problem.
Air Medical Journal
13:10 October 1994