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Background: Many studies have commented on the usefulness of helicopter emergency medical services (HEMS) for the transportation of trauma patients. However, several studies have also noted that the majority of patients transported by HEMS to Level I trauma centers had minor injuries, and warned of inappropriate use of HEMS and the need for appropriate prehospital triage. In Japan, information about the injury severity of trauma patients transported by HEMS is lacking, and the appropriateness of field triage performed by HEMS is not clear. The purpose of this study was to investigate the validity of HEMS transportation in terms of the injury severity of trauma patients who were transported to our Emergency and Critical Care Medical Center (ECCMC) in Fukushima, Japan. Methods: We retrospectively evaluated all trauma patients who were brought to our ECCMC from the scene of an accident between March 1, 2009 and January 31, 2012. We compared Injury Severity Score (ISS), Revised Trauma Score (RTS), and probability of survival (Ps) as indicators of trauma severity, and emergency operation rate, intensive care unit (ICU) admission rate, and mechanical ventilation rate as indicators of specialized trauma care between patients transported by HEMS and those transported by ground ambulance (GA). Results: We identified 450 trauma patients (324 males and 126 females, aged 51±24 years), of which 110 (24.4%) were transported by HEMS. The HEMS group had significantly more severe trauma than the GA group (ISS: 17.7±11.5 vs. 12.4±9.5, p<0.001; RTS: 6.8±1.8 vs. 7.4±1.1, p<0.01; Ps: 0.82±0.29 vs. 0.92±0.19, p<0.01, respectively), and needed significantly more specialized trauma care (emergency operation rate: 32.7% vs. 20.6%, p<0.01; ICU admission rate: 52.7% vs. 32.6%, p<0.001; mechanical ventilation rate: 41.8% vs. 17.6%, p<0.001, respectively). Discussion: HEMS field triage by flight medical teams is almost ideal in terms of the injury severity of patients transported to our ECCMC. This triage is one of the great advantages of the service. Dispatchers should activate HEMS without hesitation if severe injury is suspected. Some over-triage by dispatchers is justified because flight medical teams provide important secondary triage, including further evaluation of trauma severity and choosing of the most appropriate hospital for treatment.【背景】ヘリコプター救急システムhelicopter emergency medical services: HEMSの外傷症例に対する有用性は多くの報告で示唆されている。一方で外傷症例の重症度の観点からHEMSにおける不適切な現場トリアージに警鐘を鳴らす報告もある。本邦においてはHEMSドクターヘリで搬送された外傷症例の重症度および現場トリアージの実態は明らかになっていない。【対象および方法】2009年3月1日から2012年1月31日の期間に当院救命救急センターへ現場から直接搬送された全ての鈍的外傷症例を後方視的に調査し重症度Injury Severity ScoreISSRevised Trauma ScoreRTSProbability of survivalPs入院後管理緊急手術率ICU収容率機械換気率についてHEMS群と救急車ground ambulance: GA群で比較検討した。【結果】450症例男性324名年齢 51±24歳が特定され110例24.4%がHEMSで搬送されていた。HEMS群はGA群に比較して有意に重症でISS 17.7±11.5 vs. 12.4±9.5p<0.001RTS 6.8±1.8 vs. 7.4±1.1p<0.01Ps 0.82±0.29 vs. 0.92±0.19p<0.01有意に多く特別なケアを必要としていた緊急手術率 32.7% vs. 20.6%p<0.01ICU 収容率 52.7% vs. 32.6%p<0.001機械換気率 41.8% vs. 17.6%p<0.001。【考察】重症外傷症例がHEMSにより適切にトリアージされ当院救命救急センターに搬送されていた。HEMSには適切な2次トリアージ効果が備わっているため要請側は疑ったら躊躇せずHEMSを始動すべきでありオーバートリアージは許容されるべきである

Helicopter emergency medical services (doctor-helicopters) in Fukushima provide appropriate field triage for trauma patients