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Stellenwert der Luftrettung in der Traumaversorgung

Significance of air rescue in trauma care

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„If a man is in need of rescue, an airplane can come in and throw flowers on him and that’s just about all. But a direct lift aircraft could come in and save his life.“

Igor Sikorsky

Zusammenfassung

Der Stellenwert einzelner Interventionen im notfallmedizinischen Behandlungskonzept des Polytraumas ist differenziert zu betrachten. Oftmals wird die Luftrettung den bodengebundenen Rettungsmitteln gegenübergestellt. Dabei bleibt unberücksichtigt, dass die Luftrettung keine Entität per se darstellt. Unterschiede beziehen sich vielmehr auf das fallweise schnellere Eintreffen am Notfallort, auf Umfang und Qualität der notärztlichen Intervention und den dabei notwendigen Zeitbedarf sowie auf den schnelleren Transport in weiter entfernte Behandlungseinrichtungen. In einer Gewichtung der einzelnen Maßnahmen hat der unmittelbare, zeitnahe Transport von polytraumatisierten Patienten an ein Traumazentrum die höchste Priorität. Der Einsatz des RTH ist bei bestimmten Subgruppen (Injury Severity Score, ISS ≥12; schweres Schädel-Hirn-Trauma) mit einem deutlich besseren Patientenoutcome korreliert. Kompetente notärztliche Intervention verbessert das Kurzzeitüberleben, verkürzt die notwendige Behandlungsdauer im Schockraum, auf der Intensivstation und im Krankenhaus. Die daraus resultierende Zunahme der präklinischen Behandlungszeit hat keinen negativen Einfluss auf das Outcome. Basierend auf der derzeitig verfügbaren Literatur erscheint der hohe Stellenwert der Luftrettung in der Traumaversorgung gesichert.

Abstract

Pre-hospital trauma management is complex and merits a distinct evaluation. In order to assess the efficacy of the entire chain of survival, helicopter emergency medical service systems (HEMS) are often compared with ground EMS. Since HEMS may not be considered as an entity, differences and similarities between both systems should be recognized: 1. response times may be shorter when a helicopter is employed; 2. emergency medical care may be similar or more comprehensive; 3. patient transport to a Level 1 trauma center is typically faster. According to priority, minimizing patient transport time to a definitive care facility may have the greatest impact on survival; and the subgroup of air lifted trauma patients with an Injury Severity Score (ISS) ≥12 or severe brain trauma may benefit the most. In addition, advanced life support improves short term survival, and reduces emergency room, intensive care and hospital time for treatment. When ALS is indicated and interventions are performed professionally, the additional on-scene time needed will not affect outcome. Based on the literature currently available, the value of air rescue in trauma care appears to be warranted.

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Authors and Affiliations

  1. Universitätsklinik für Anästhesiologie und allgemeine Intensivmedizin, Medizinische Universität Innsbruck, Anichstraße 35, 6020, Innsbruck, Österreich

    W.G. Voelckel M.Sc., DEAA

  2. Abteilung für Anästhesie, Notfall- und allgemeine Intensivmedizin, Landesklinikum Wiener Neustadt, Wien, Österreich

    H. Trimmel

  3. Christophorus Flugrettungsverein, Wien, Österreich

    W.G. Voelckel M.Sc., DEAA & H. Trimmel

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  1. W.G. Voelckel M.Sc., DEAA
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  2. H. Trimmel
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Correspondence to W.G. Voelckel M.Sc., DEAA.

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Voelckel, W., Trimmel, H. Stellenwert der Luftrettung in der Traumaversorgung. Notfall Rettungsmed 11, 240–245 (2008). https://doi.org/10.1007/s10049-008-1056-2

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