Prehospital advanced life support provided by specially trained physicians: is there a benefit in terms of life years gained?

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Abstract:

Background: 

The benefit of prehospital advanced life support (ALS) is disputed, as is the prehospital use of specially trained, hospital-based physicians. The purpose of the study was to assess the health benefit from an anesthesiologist-manned prehospital emergency medical service (EMS), and to separate the benefit of the anesthesiologist from that of rapid transport. Methods:

 The anesthesiologist-manned helicopter and rapid response car service at Rogaland Central Hospital assisted 1106 patients at the scene during the 18-month study period. Two expert panels assessed patients with a potential health benefit for life years gained (LYG) using a modified Delphi technique. The probability of survival as a result of the studied EMS was multiplied by the life expectancy of each patient. The benefit was attributed either to the anesthesiologist, the rapid transport or a combination of both. Results:

 The expert panels estimated a benefit of 504 LYG in 74 patients (7% of the total study population), with a median age of 54 years (range 0–88). The cause of the emergency was cardiac diseases (including cardiac arrest) in 61% of the 74 patients, trauma in 19%, and cardio-respiratory failure as a result of other conditions in 20%. The LYG were equally divided between air and ground missions, and the majority (88%) were attributed solely to ALS by the anesthesiologist. Conclusion: 

The expert panels found LYG in every 14th patient assisted by this anesthesiologist-manned prehospital EMS. There was no difference in LYG between the helicopter and the rapid response car missions. The role of the anesthesiologist was crucial for health benefits.

Keywords: advanced life support; air ambulance service; emergency medical service; life years gained; prehospital emergency medicine

Document Type: Research Article

DOI: http://dx.doi.org/10.1034/j.1399-6576.2002.460703.x

Affiliations: 1: Department of Anesthesia and Intensive Care, Rogaland Central Hospital, Stavanger, 2: Institute of Community Medicine, University of Tromsø, Tromsø and 3: Department of Emergency Medical Services, Division of Surgery, Ullevål University Hospital, Oslo, Norway

Publication date: August 1, 2002

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