Attendees were treated to an irreverent and timely review of 15 studies published in the last year. W. Richard Bukata, MD, clinical professor emergency medicine at the Los Angeles County/University of Southern California, and Jerome R. Hoffman, MD, FACEP, professor of medicine emeritus at UCLA School of Medicine in Los Angeles, led the interactive discussion that covered a range of topics.
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The first five studies focused on issues involving emergency medical services (EMS), including a 2015 study on the “Outcomes After Out-of-Hospital Cardiac Arrest Treated by Basic vs. Advanced Life Support” by Sanghavi et al. Speakers discussed the study that showed patients who received basic life support (BLS) following an out-of-hospital cardiac arrest fared better than patients who were treated by personnel with advanced life support (ALS) skills.
“The difference is only slight,” admitted Dr. Hoffman, who noted similar results from other studies, including the definitive Ontario Prehospital Advanced Life Support Study (OPALS). The key, he said, is early CPR—usually from bystanders—and early application of a defibrillator. “Everything else is just wasted time,” he said.
A Maryland retrospective study evaluating a change in the triage guidelines to require physician preapproval of helicopter transport for patients within a 30-minute drive of a trauma center, revealed that, even with a decline of 78.2 percent in helicopter transports, there was no adverse outcome for these patients. “I don’t think there is any place for helicopter transports in a big city at all,” stated Dr. Hoffman.
Dr. Bukata felt that there might be cause to use a helicopter in an urban setting during peak traffic times when gridlock could delay ground transport, but agreed that it is overused in most cases. “The cost-benefit is crazy unless doing it safely and where there are really long transport times,” he said. “That’s where you should have helicopter transport.”
The two physicians were in complete agreement regarding research that examined overtriage to trauma centers based solely on motor vehicle intrusion. The study by Matsushima et al published in the Emergency Medical Abstracts in January 2016 confirmed that using this mechanism of injury results in significant overtriage to trauma centers. “We’ve known this for a long time,” Dr. Hoffman said. “The only thing that predicts in any reasonable way is patient assessment, meaning any physical or historical sign that’s worrisome.”
The study examined nearly 40,000 patients who were transported to a trauma center because of this mechanism. Of those, four patients sustained injuries significant enough to require a trauma center.