Helicopter interventions at polytraumatized patients in North-East of Romania

Diana Cimpoesu1,2, Claudia Bursuc2, Bogdan Zamfir2,3, Vladimir Makkai2

University of Medicine and Pharmacy Gr.T.Popa Iasi Sf.Spiridon University Emergency County Hospital Iasi Dr.Iacob Czihac Military Emergency Hospital Iasi

Background: The polytraumatism is the third cause of death in all age group. The younger are
the most exposed to this. Romania is on the third place in Europe about deceases from car accidents. It is easy to imagine that, depending on the magnitude of the accident, the distance between the place of the event and the level of training available medical crews, time of arrival of the first victims to hospital shows a great variety.

Objectives: Evaluation of the traumatized patients that were transported with the helicopter
from all the North-East region.

Methods: Retrospective study of the interventions of SMURD helicopter for polytraumatized

patients in the North-East Romania between March 2011 March 2013. North-East Romania has 30,949 km and 3.84 million inhabitants. It was intervened with an MI8 helicopter and a Eurocopter135 helicopter, having mobile intensive care medical equipment, 2 pilots, 1 emergency physician and 1 nurse. This helicopter serves all the region, adults and children.

Results: The study considers 88 patients, average age

(72%) and adults (68,2%).

34,342,772 years, predominantly male

The interventions were 29.5% primary (on site emergency response and transport victim to the nearest competent hospital or patient in a medical unit of less than 3 hours) and 70.5% secondary (intervention for transporting a critical patient hospitalized in a medical unit to another unit that competence in solving case ). Most interventions occurred in winter (38.6%) burns - and spring (27.3%) car accidents - and during the week (62.5%). The largest number of helicopter interventions, were in the counties Iasi (33%), Vaslui (29.5%) and Suceava (17%). Cases taken by ESA (air rescue crew) were

directed to Iasi (76.1%) and the rest to Bucharest (especially burns and spinal medullar injuries). A percentage of 3.4% of victims did not require transfer as intervention resulted in patient death. The mean intervention in Iasi is 20 minutes by air compared to 45 minutes by road, for Vaslui time is 30 minutes by air and by road of 80 minutes, for Suceava time is 45 minutes by air 120 minutes by road. The predominant mechanism is burn trauma (26.1%) followed by car accidents (22.7%) and falls from height (13.6%). Brain injury (56,8% ) and chest trauma (27,2%) were the most common. The most common combination was lesional brain injury and chest trauma and brain injury with severe trauma limbs. Most patients did not require oro-tracheal intubation (56.8%) but were given large amounts of fluid (1000 ml - 63.6%), major analgesics opioid (43.2%) and sedation (46,6%) correlated with RTS (p<0,001). The average revised trauma score (RTS) was 10.26 0.246. The average RTS was the highest for train crash (12p) and the lowest (5,6p) for the hanging. Oro-tracheal intubation rate was 43.2% (predominantly accidents and burns) correlated with RTS (p <0.001). Death rate during interventions was 3,4% and the patients with cardiac arrest were 6,8%.

Conclusions: The intervention by air is justified for: shorter time intervention (a quarter of that
required intervention by road), extremely important in the case of time-dependent diseases (acute coronary syndrome, emergency neurosurgical intervention, ensuring the effective therapies for burns) road infrastructure can be a real problem especially in cases of spinal medullar lesions, brain injuries or, mobilizing medical crew county Ambulance Service by road to transfer a critical patient to Iasi lead to difficulties in emergency medical assistance or county (small number of physicians, long time for travel).