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

项目摘要 在美国农村受伤的患者比城市患者更有可能死亡。这在一定程度上是由于贫穷。 获得区域创伤中心等专门护理的机会，农村患者更有可能被带到 结果就是非创伤中心。对于农村患者，直升机空中医疗运输(AMT)是唯一的途径 由于前往创伤中心的地理位置不佳，及时获得救命的创伤护理。AMT带来 甚至在到达创伤之前，地面救护车也无法为患者提供救生护理。 并更快地将患者送往创伤中心接受明确的治疗。如果使用得当，AMT可以 减轻这种分流不足的情况，并在受伤后拯救生命。在偏远的农村地区，AMT的使用也可能保留 为其他患者提供当地应急资源。不必要地使用AMT--过度分类--在UP中发生 至60%的直升机飞行患者只受轻伤，在农村地区也较为常见。一个 AMT分诊不准确的主要原因是缺乏对哪些患者和/或 情况需要使用AMT，这反映在先前文献中使用的测量方法的显著差异中 对于适当的AMT。这使得无法比较或建立在先前工作的基础上，这是一个关键障碍 以改进农村患者的空中医疗分流。不准确的AMT分诊不成比例地影响患者 农村地区服务不足，并产生严重的负面后果：农村患者分诊不足增加了 不把他们送到可以治疗他们受伤的设施，有死亡的风险。过度分类，不必要的AMT， 增加了成本，使这种稀缺的资源对其他需要它的患者不可用，并增加了 病人和船员。AMT撞车事故是一个严重的安全问题，三分之一的撞车事故会造成人员伤亡 相比之下，只有1%的地面救护车坠毁，如果飞行是不必要的，这是一个可以避免的风险。进一步，金额 每次运输的费用超过10,000美元，给患者和医疗系统带来了巨大的经济负担。 该提案寻求通过多个组织的共识来制定受伤后AMT需求的第一个定义 与院前创伤护理和地区性护理提供专家的不同观点。这个项目将 然后使用实际的患者结果来验证该定义。在目标1中，我们将使用基于Web的实时修改 Delphi方法制定了一个一致的标准定义，以保证创伤后AMT。在《目标2》中我们将 评估我们对AMT需求的共识定义的多个方面的有效性。我们将征求反馈意见 农村EMS专业人员对面子效度进行评估并细化定义。然后我们将评估标准的有效性 通过将该定义应用于州创伤登记中的患者，以评估那些确实这样做的人和那些确实这样做的人的结果 不符合定义。这一建议是发展基于证据的空中医疗分诊的基础 指导方针，并将使用这一共识定义为未来的工作提供信息，以前瞻性地验证、实施和 试行空中医疗分类算法。成功完成将改善结果和创伤护理价值， 通过在正确的时间为正确的患者提供正确的护理，减少美国农村地区受伤后的差距。

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.