PubMed · 14762988
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Vaughan Askue. Fly-by-wire.. https://doi.org/10.1016/j.amj.2003.08.001
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BACKGROUND: The aim of this study was to demonstrate differences in structure and severity of pediatric emergencies treated by aeromedical (air rescue) or ground ambulances services. Conclusions for the training of emergency physicians are discussed. PATIENTS AND METHODS: In a 3-year study period, a total of 9,274 pediatric emergencies covered by the ADAC air rescue service are compared to 4,344 pediatric patients of ground ambulance services in Saarland. RESULTS: In aeromedical services pediatric emergencies are more frequent (12.9% vs. 6.4%), trauma predominates (59.9% vs. 35.6%) and severe injuries or diseases occur more frequently (30.5% vs. 15.0%). In both groups pediatric emergency cases are concentrated into very few diagnostic groups: more than one third of the cases involving pre-school children is due to convulsions. Respiratory diseases and intoxication are the next most frequent causes and are more common in ground ambulance patients. Head trauma is the most common diagnosis in cases of pediatric trauma, followed by musculoskeletal and thoracoabdominal trauma. All types of severe trauma are more frequent in pediatric patients of the aeromedical services. CONCLUSIONS: Training of emergency physicians should include pediatric life support and specific information about frequent pediatric emergency situations. For emergency physicians in aeromedical services, an intensive training in pediatric trauma life support is also necessary.
BACKGROUND: Neonatal transports carry risk of complications and technical mishaps which may cause deterioration of the patient's condition. MATERIAL AND METHODS: Prospective observational study on all transports from the subregional neonatal unit, Vestfold Hospital, Norway to other hospitals during the 23-year period 1982-2004. RESULTS: 396 transports were undertaken with a total of 359 patients, 0.7% of live born infants (n = 49,250). Indications were prematurity/respiratory distress syndrome (RDS) in 84 (21%), congenital malformations in 188 (47%), and other conditions in 124 (31%). After the establishment a local respirator programme 1989, transports for prematurity/RDS declined significantly from the 7-year period 1982 - 88 to the 16-year period 1989-2004 (3.4 vs. 1.0 per 1000 live born infants ;p < 0.0001). Night-time transports declined by 55 %. Technical mishaps occurred in 4% of the transports. No deaths occurred during transport; however, 10 infants (2.8%) died within 24 hours on arrival. INTERPRETATION: Neonatal transports were associated with risk of deterioration. High local competence and up-to-date technical equipment for neonatal intensive care improve the quality of transport, reduce the incidence of transports of premature infants with RDS, and of transports during night-time.
CONTEXT: Previous studies have reported that the number and distribution of trauma centers are uneven across states, suggesting large differences in access to trauma center care. OBJECTIVE: To estimate the proportion of US residents having access to trauma centers within 45 and 60 minutes. DESIGN AND SETTING: Cross-sectional study using data from 2 national databases as part of the Trauma Resource Allocation Model for Ambulances and Hospitals (TRAMAH) project. Trauma centers, base helipads, and block group population were counted for all 50 states and the District of Columbia as of January 2005. MAIN OUTCOME MEASURES: Percentages of national, regional, and state populations having access to all 703 level I, II, and III trauma centers in the United States by either ground ambulance or helicopter within 45 and 60 minutes. RESULTS: An estimated 69.2% and 84.1% of all US residents had access to a level I or II trauma center within 45 and 60 minutes, respectively. The 46.7 million Americans who had no access within an hour lived mostly in rural areas, whereas the 42.8 million Americans who had access to 20 or more level I or II trauma centers within an hour lived mostly in urban areas. Within 45 and 60 minutes, respectively, 26.7% and 27.7% of US residents had access to level I or II trauma centers by helicopter only and 1.9% and 3.1% of US residents had access to level I or II centers only from trauma centers or base helipads outside their home states. CONCLUSION: Selecting trauma centers based on geographic need, appropriately locating medical helicopter bases, and establishing formal agreements for sharing trauma care resources across states should be considered to improve access to trauma care in the United States.