Establishing a consensus-based definition of air medical transport need for rural patients after injury

建立基于共识的农村患者受伤后航空医疗运输需求定义

• 批准号: 10811026
• 负责人: Joshua B Brown
• 金额: $ 25.35万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-22 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10811026
• 关键词: Air; Algorithms; Ambulances; Blood Transfusion; Caring; Consensus; Data; Decision Making; Disparity; Emergency Medicine; Emergency medical service; Emergency response; Face; Feedback; Fees; Financial Hardship; Future; Geography; Goals; Guidelines; Healthcare Systems; Helicopter; Hospitals; Hour; Injury; Intervention; Life; Literature; Measures; Medical; Medical emergency; Methodology; Methods; Minor; Online Systems; Outcome; Outcome Assessment; Patient-Focused Outcomes; Patients; Pattern; Persons; Physiology; Pre-hospitalization care; Registries; Research; Resources; Risk; Rural; Rural Population; Safety; Standardization; Surveys; System; Time; Trauma; Trauma patient; Triage; Validation; Variant; Work; care delivery; cost; data registry; disparity reduction; evidence base; experience; first responder; high risk; improved; improved outcome; injured; innovation; meetings; mortality risk; multidisciplinary; novel; patient oriented; patient safety; patient subsets; preservation; prospective; recruit; rural America; rural Americans; rural area; rural patients; severe injury; tool; trauma care; trauma centers; underserved rural area

PROJECT ABSTRACT Patients injured in rural America are more likely to die than their urban counterparts. This is due in part to poor access to specialized care such as regional trauma centers, and rural patients are more likely to be taken to a non-trauma center as a result. For rural patients, air medical transport (AMT) by helicopter is the only way to get timely access to life-saving trauma care because of poor geographic access to trauma centers. AMT brings life-saving care otherwise unavailable from ground ambulances to the patient even before reaching a trauma center and gets the patient to definitive care at a trauma center faster. AMT when used appropriately can mitigate this under-triage and save lives after injury. In remote rural regions, use of AMT may also preserve local emergency response resources for other patients. Unnecessary use of AMT – over-triage – occurs in up to 60% of helicopter flights for patients with only minor injuries and is also more common in rural areas. A major driver of this inaccurate triage for AMT is the lack of a standardize definition of what patients and/or circumstances warrant the use of AMT, reflected in significant variation in the measures used in prior literature for appropriate AMT. This makes it impossible to compared or build on prior work, representing a critical barrier to improving air medical triage of rural patients. Inaccurate AMT triage disproportionally impacts patients in underserved rural areas and has serious negative consequences: Under-triage of rural patients increases the risk of death by not transporting them to a facility that can treat their injuries. Over-triage, unnecessary AMT, increases cost, makes this scarce resource unavailable for other patients that need it, and increases risk to the patient and the crew. AMT crashes are a serious safety issue with a third of crashes experiencing a fatality compared to just 1% of ground ambulance crashes, an avoidable risk if the flight is unnecessary. Further, AMT fees are over $10,000 per transport, creating a significant financial burden for patients and healthcare systems. This proposal seeks to develop the first definition of AMT need after injury through consensus from multiple diverse perspectives with experts in prehospital trauma care and regionalized care delivery. This project will then validate the definition using actual patient outcomes. In Aim 1 we will use web-based real-time modified Delphi methods to develop a consensus definition of criteria that warrant AMT after trauma. In Aim 2 we will assess the multiple aspects of validity for our consensus definition of AMT need. We will solicit feedback from rural EMS professionals to assess face validity and refine the definition. We will then assess criterion validity by applying the definition to patients in a state trauma registry to assess outcomes among those that do and do not meet the definition. This proposal is foundational to developing evidence-based air medical triage guidelines and will inform future work using this consensus definition to prospectively validate, implement, and pilot an air medical triage algorithm. Successful completion will improve outcomes and trauma care value, reducing the disparities after injury in rural America by getting the right patients the right care at the right time.

项目摘要 在美国农村受伤的患者比城市同行更有可能死亡。这部分归因于差 获得特殊护理（例如区域创伤中心），并且更可能将其带到 因此，非创伤中心。对于粗糙的患者，直升机的空中医疗运输（AMT）是唯一的方法 由于地理位置不佳，可以及时获得挽救生命的创伤护理。 AMT带来 挽救生命的护理否则就无法从地面救护车到患者到达创伤之前 中心，使患者更快地在创伤中心进行确定的护理。适当使用时AMT可以 减轻这种不足的水平，并在受伤后挽救生命。在偏远的农村地区，AMT的使用也可以保留 其他患者的当地应急资源。不必要的AMT使用 - 过度限制 - 发生在UP中 只有仅轻伤的患者的直升机飞行中有60％在农村地区也更为常见。一个 该AMT不准确的分类的主要驱动力是缺乏对患者和/或的标准化定义 情况值得使用AMT，反映在先前文献中使用的措施中的显着差异 适合适当的amt。这使得不可能在先前的工作上进行比较或建立，代表一个关键的障碍 改善粗糙患者的空气医疗分类。不准确的AMT Triage不成比例地影响患者 服务不足的农村地区有严重的负面后果：农村患者的资产不足增加了 通过不将其运送到可以治疗其伤害的设施而出现死亡的风险。过度交易，不必要的AMT， 增加成本，使得其他需要它的患者无法获得这种稀缺资源，并增加了风险 病人和船员。 AMT崩溃是一个严重的安全问题，三分之一的撞车事故发生死亡 相比之下，只有地面救护车坠毁的1％，如果不需要飞行，则可以避免的风险。此外，AMT 每辆运输的费用超过10,000美元，为患者和医疗保健系统造成了巨大的财务燃烧。 该提议旨在通过通过多个共识来制定AMT需求的第一个定义 与院前创伤护理和区域化护理交付专家的不同观点。这个项目将 然后使用实际的患者结果验证定义。在AIM 1中，我们将使用基于Web的实时修改 Delphi方法是为了制定一定的标准定义，该标准保留创伤后的AMT。在目标2中，我们将 评估有效性的多个方面，以达到我们对AMT需求的共识定义。我们将从 农村EMS专业人员评估面部有效性并完善定义。然后，我们将评估标准有效性 通过将定义应用于州创伤注册表中的患者，以评估那些做和做的结果 不符合定义。该提案是开发循证空气医疗分类的基础 准则，并将使用此共识定义为未来的工作提供信息，以实现，实施和 飞行员Air Medical Triage算法。成功完成将提高成果和创伤护理价值， 通过在正确的时间为合适的患者提供正确的患者，从而减少了美国农村地区的分布。