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 美国农村地区受伤的患者比城市患者更有可能死亡，部分原因是贫困。 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送往医疗机构 因此，对于农村患者来说，直升机空中医疗运输 (AMT) 是前往非创伤中心的唯一途径。 由于 AMT 前往创伤中心的地理条件较差，因此能够及时获得挽救生命的创伤护理。 否则，即使在到达创伤之前，地面救护车也无法为患者提供救生护理 如果使用得当，AMT 可以更快地让患者在创伤中心得到明确的护理。 在偏远农村地区，使用 AMT 还可以减少分类不足的情况并挽救生命。 对其他患者不必要地使用 AMT（过度分类）的情况发生在上。 60% 的直升机飞行只针对轻伤患者，这在农村地区也更为常见。 AMT 分类不准确的主要原因是缺乏对患者和/或患者的标准化定义 情况需要使用 AMT，这反映在先前文献中使用的措施存在显着差异 这使得无法比较或建立之前的工作，这是一个关键障碍。 改善农村患者的空中医疗分诊 不准确的 AMT 分诊对农村患者的影响尤为严重。 农村地区服务不足，并产生严重的负面后果：对农村患者的分类不足增加了 不将他们送往可以治疗其伤势的机构，会带来死亡风险 过度分诊、不必要的 AMT、 增加了成本，使其他有需要的患者无法获得这种稀缺资源，并增加了风险 AMT 事故是一个严重的安全问题，三分之一的事故导致死亡。 与只有 1% 的地面救护车事故相比，如果不需要飞行，AMT 的风险是可以避免的。 每次运输的费用超过 10,000 美元，给患者和医疗保健系统造成了巨大的经济负担。 该提案旨在通过多方的共识，制定受伤后 AMT 需求的第一个定义。 该项目将与院前创伤护理和区域化护理服务领域的专家提出不同的观点。 然后使用实际患者结果验证定义。在目标 1 中，我们将使用基于网络的实时修改。 在目标 2 中，我们将采用德尔菲法制定创伤后 AMT 标准的共识定义。 评估我们对 AMT 需求的共识定义的有效性的多个方面。 EMS 专业人员评估农村有效性并完善定义，然后我们将评估标准有效性。 通过将定义应用于国家创伤登记处的患者来评估那些做过和做过的人的结果 该提案是开发基于证据的空中医疗分类的基础。 指南，并将使用此共识定义为未来的工作提供前瞻性验证、实施和 成功完成空中医疗分类算法试点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来减少美国农村受伤后的差异。