Abstract 12303: Physician Staffed Emergency Helicopter Transport of Patients With ST Elevation Myocardial Infarction Improves Outcomes Compared to Helicopter Transport Without Physicians
Objective: Helicopter Emergency Medical Services (HEMS) commonly transport patients with ST Elevation Myocardial Infarction (STEMI) to hospitals that can perform timely percutaneous coronary intervention. HEMS typically consist of paramedics and flight nurses who have advanced cardiac life support skills; however, a number of services also employ Emergency Medicine physicians. Physician-staffed crews may offer enhanced emergency care at the scene and during transport; however, the impact of physician-staffed HEMS on patient outcomes for STEMI is unknown. We hypothesized that physician staffed HEMS for STEMI transport improves patient outcomes compared to non-physician staffed HEMS.
Methods: U. Wisconsin Hospital & Clinics receives STEMI patients via physician and non-physician staffed HEMS. Demographic, in-transport and in-hospital data was retrospectively collected from the University of Wisconsin Hospital and Clinics contribution to the National Cardiovascular Data Registry (NCDR), electronic medical record and HEMS flight record between August 2006 and June 2012. In-transport and in-hospital adverse events including death, stroke, cardiac arrest, major arrhythmia, respiratory failure requiring advanced airway, hypotension and recurrent MI were recorded. The primary endpoint was defined as the composite of mortality and/or NCDR defined adverse events.
Results: 327 subjects transported by physician HEMS and 23 by non-physician HEMS in the study period. Age, sex, Killip Class, infarct location were similar between groups. Median flight distance, regional door to STEMI activation, and in-transport adverse events were also similar between groups. The primary endpoint was significantly improved for the physician HEMS group vs. the non-physician HEMS group (19% vs. 43% respectively, p=0.013). Serious arrhythmias were also less frequent (3% vs. 13%, p=0.037). Mortality was lower with physician HEMS vs. non-physician HEMS, but this did not reach statistical significance (5% versus 9%; p=0.33).
Conclusion: In this retrospective, single center study, subjects with STEMI who were transported via physician staffed HEMS appeared to have improved in-hospital outcomes compared to those transported by non-physician staffed HEMS.
- © 2013 by American Heart Association, Inc.