重症頭部外傷初期診療におけるドクターヘリの有用性

DOI 被引用文献2件 参考文献21件

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  • Usefulness of the Doctor-Helicopter System for the Primary Treatment of Severe Head Injury

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To evaluate the usefulness of the doctor-helicopter system for the primary treatment of severe head injury, we retrospectively examined the primary treatment and outcomes in patients transported to our hospital using the doctor-helicopter system and the those referred from other hospitals. The subjects were 42 patients with high-impact injury accompanied by severe head injury with a Glasgow coma scale (GCS) score of 8 or lower at the time of transportation to our emergency medical care center between January 2003 and March 2005. There were 20 patients transported using the doctor-helicopter system (helicopter group) and 22 patients referred from other hospitals (transfer group). Helicopter group was admitted to our hospital by a direct helicopter, transfer group was carried in a general ambulance by way of other hospitals. We examined the GCS score, injury severity score (ISS), and the presence or absence of light reflex or shock at the time of transportation to our center, the period between the injury and primary treatment, the period between the injury and surgery in patients who had undergone emergency burr hole surgery, the primary treatment (mainly the presence or absence of tracheal intubation), outcomes, and the survival rate in the helicopter and transfer groups. As a result, the number of patients with shock was significantly larger in the transfer group than in the helicopter group, and the outcomes were significantly poorer in the former than in the latter. Of the 9 patients with shock in the transfer group, appropriate administration of drugs was not performed in 4 patients, and the shock was considered to occur during the transportation. There was no significant difference in the period between the injury and primary treatment between the 2 groups, but the primary treatment was more appropriate in the helicopter group compared to that in the transfer group, suggesting that differences in the primary treatment affected the outcomes in the 2 groups. These findings suggested that outcomes of severe high-impact head injuries, such as injuries caused by a traffic accident, are markedly affected by the primary treatment. The doctor-helicopter system, in which emergency physicians arrive at the site shortly after the occurrence of injury, and start primary examination, will impact outcomes of multiple injuries accompanying severe head injury.

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