Authors' objectives:

This technical brief examined four questions:

1. In adults and children with a medical or trauma related emergency, does the presence of a medical doctor on emergency helicopter services improve health outcome when compared with transportation by emergency helicopter without a medical doctor? 2. In adults and children with a medical or trauma related emergency, does the presence of a medical doctor on a road ambulance service improve health outcome when compared with transportation by a road ambulance service without a medical doctor? 3. In adults and children with a medical or trauma related emergency, does the presence of a medical crew able to perform rapid sequence intubation and/or thoracostomy improve health outcome when compared with a medical crew unable to perform rapid sequence intubation and/or tube thoracostomy and/or thoracotomy? 4. In adults and children with a medical or trauma related emergency how does variation in the time from callout to arrival at a medical facility with definitive care influence health outcome?

There are two general strategies about pre-hospital transportation: "scoop and run" and "stay and treat". Scoop and run consists of short times at the scene with the emphasis being to transport the patient to definitive care as quickly as possible. In contrast, stay and treat involves longer times at the scene in order to start the stabilisation process. The above questions were designed to help address the most appropriate transportation strategy.

Authors' recommendations: Key results were: 1. There was generally more support for the inclusion of doctors on helicopters in the seven studies appraised in this section. However, there were uncertainties due to study design issues (levels of evidence ranged between III-1 and III-3), lack of consideration about whether non-doctor groups can be trained to perform certain procedures that would improve patient outcome and whether there may be different clinical scenarios that would favour one crew mix over another. 2. Similar considerations applied in the studies examining the use of doctors on board road ambulances. There were four studies in this section with levels of evidence ranging between III-2 and III-3. 3. When considering the outcome in patients who were treated by crews able to perform rapid sequence intubation and/or thoracostomy with other crews who were not able to perform these procedures, the only studies identified that met the study eligibility criteria included doctors amongst those able to perform the procedures of interest. It was therefore not possible to form conclusions about the effectiveness of non-doctor crews able to perform the procedures of interest when compared with crews that included a doctor. There were five studies in this section with levels of evidence ranging between III-1 and III-3. 4. There was inconsistent data on the association between pre-hospital time and patient outcome. However, the general direction was to support improved outcome in association with shorter pre-hospital times. Two studies provided information to consider whether crew mix or rapid transport had a more significant bearing on outcome. The results were conflicting across these two studies. There were 21 studies in this section with levels of evidence all being III-2. 5. Most of the studies included related to trauma rather than medical emergencies. 6. There was insufficient information to consider subgroups based on injury severity or age group. While the balance of studies support improved outcome associated with doctors on board emergency transportation, the robustness of these studies and the areas of uncertainty that remain (see under research gaps) provide uncertainty about the best approach. The best study supported the use of doctors on board helicopters. The balance of studies supported improved outcome associated with shorter prehospital times. The studies identifying improved outcome frequently assessed the linear relationship between pre-hospital outcome and time, meaning that the focus was on any improvement in outcome rather than a set threshold of pre-hospital time to meet in order to achieve improved outcome.

Authors' methods: Review

Project Status: Completed

URL for project: http://nzhta.chmeds.ac.nz/publications.htm

Year Published: 2007

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: New Zealand

Organisation Name: New Zealand Health Technology Assessment

Contact Address: Department of Public Health and General Practice, Christchurch School of Medicine and Health Sciences, University of Otago, P.O. Box 4345, Christchurch, New Zealand. Tel: +64 3 364 1145; Fax: +64 3 364 1152;

Contact Name: nzhta@chmeds.ac.nz

Contact Email: nzhta@chmeds.ac.nz

Copyright: New Zealand Health Technology Assessment (NZHTA)