Brodie Nolan1, Alun Ackery1, Sol Mamakwa2, Shari Glenn3, David VanderBurgh4, Aaron Orkin5, Michael Kirlew6, Evelyn Dell1, Homer Tien7. 1. Ornge Air Ambulance, 5310 Explorer Drive, Mississauga, Ontario, L5W 5H8, Canada. 2. NAN, 100 Back Street Unit 200, Thunder Bay, Ontario P7J 1L2, Canada. 3. Health Canada, 2720 Riverside Drive, Ottawa, Ontario K1A 0K9, Canada. 4. Dept Emergency Med, Thunder Bay Regional Health Centre, 980 Oliver Road, Thunder Bay, Ontario P7B 6V4, Canada. 5. Dept Emergency Med, Mt Sinai Hospital, 600 Unviersity Avenue, Toronto, Ontario M5G1X5, Canada. 6. Meno Ya Win Health Centre, 1 Meno Ya Win Way, Sioux Lookout, Ontario P8T1B4, Canada. 7. Ornge Air Ambulance, 5310 Explorer Drive, Mississauga, Ontario, L5W 5H8, Canada. Electronic address: homer.tien@sunnybrook.ca.
Abstract
INTRODUCTION: Nursing stations are the only access point into the health care system for some communities and have limited capabilities and resources. We describe characteristics of patients injured in Northern Ontario who present to nursing stations and require transport by air ambulance. Secondary objectives are to compare interventions performed at nursing stations with those performed by flight paramedics and to identify systemic gaps in trauma care. METHODS: A retrospective cohort study was performed of all injured patients transported by air ambulance from April 1, 2014, to March 31, 2015. RESULTS: A total of 125 injured patients were transported from nursing stations. Blunt trauma accounted for 82.5% of injuries, and alcohol intoxication was suspected in 41.6% of patients. The most frequently performed interventions were intravenous fluids and analgesia. Paramedics administered oxygen 62.4% of the time, whereas nursing stations only applied in 8.8% of cases. Flight paramedics were the only providers to intubate and administer tranexamic acid, mannitol, or vasopressors. CONCLUSION: Care for patients at nursing stations may be improved by updating the drug formulary based on gap analyses. Further research should examine the role of telemedicine support for nursing station staff and the use of point-of-care devices to screen for traumatic intracranial hemorrhage. Crown
INTRODUCTION: Nursing stations are the only access point into the health care system for some communities and have limited capabilities and resources. We describe characteristics of patients injured in Northern Ontario who present to nursing stations and require transport by air ambulance. Secondary objectives are to compare interventions performed at nursing stations with those performed by flight paramedics and to identify systemic gaps in trauma care. METHODS: A retrospective cohort study was performed of all injured patients transported by air ambulance from April 1, 2014, to March 31, 2015. RESULTS: A total of 125 injured patients were transported from nursing stations. Blunt trauma accounted for 82.5% of injuries, and alcohol intoxication was suspected in 41.6% of patients. The most frequently performed interventions were intravenous fluids and analgesia. Paramedics administered oxygen 62.4% of the time, whereas nursing stations only applied in 8.8% of cases. Flight paramedics were the only providers to intubate and administer tranexamic acid, mannitol, or vasopressors. CONCLUSION: Care for patients at nursing stations may be improved by updating the drug formulary based on gap analyses. Further research should examine the role of telemedicine support for nursing station staff and the use of point-of-care devices to screen for traumatic intracranial hemorrhage. Crown
Authors: David VanderBurgh; David W Savage; Sacha Dubois; Natalie Binguis; Sadie Maxwell; Natalie Bocking; Terri Farrell; Homer Tien; Stephen D Ritchie; Aaron Orkin Journal: CMAJ Open Date: 2020-05-23