National consensus on communication in prehospital trauma care, the DENIM study.

Background: In the Netherlands prehospital trauma care is provided by emergency medical services (EMS) nurses. This care is extended by Physician staffed Helicopter Emergency Medical Services (P-HEMS) for the more severely injured patient. Prehospital communication is a factor of influence on the identification of these patients and the dispatch of P-HEMS.

Limitations in Prehospital Communication Between Trauma Helicopter, Ambulance Services, and Dispatch Centers.

Background: Prehospital communication with Emergency Medical Services (EMS) is carried out in hectic situations. Proper communication among all medical personal is required to enhance collaboration, to provide the best care and enable shared situational awareness.

Objective: The objective of this article was to give insight into current Dutch prehospital emergency care communication among all EMS and evaluate the usage of a new physician staffed helicopter EMS (P-HEMS) cancellation model.

The Hypoxia Alarm of a Multigas Analyzer Is Triggered During Helicopter Takeoffs in Helicopter Emergency Medical Services Operations.

Objective: Safety in helicopter emergency medical services (HEMS) settings might be enhanced by the routine use of portable multigas analyzers to indicate hypoxic ambient air mixtures and the presence of hazardous gases.

Methods: In our HEMS (EC-135, Lifeliner 1, Amsterdam, The Netherlands), we introduced a professional multigas analyzer (Gas Alert Max XT II; Honeywell Analytics, Lincolnshire, IL) to prospectively detect possible hazardous gas mixtures. This analyzer measures ambient oxygen percentage (FO2, 0%-30%), carbon monoxide (CO, 0-1,000 ppm), hydrogen sulfide (H2S, 0-200 ppm), and combustibles (lower explosive limit, %).

Protocol of the DENIM study: a Delphi-procedure on the identification of trauma patients in need of care by physician-staffed Mobile Medical Teams in the Netherlands.

Background: In The Netherlands, standard prehospital trauma care is provided by emergency medical services and can be supplemented with advanced trauma care by Mobile Medical Teams. Due to observed over and undertriage in the dispatch of the Mobile Medical Team for major trauma patients, the accuracy of the dispatch criteria has been disputed. In order to obtain recommendations to invigorate the dispatch criteria, this study aimed at reaching consensus in expert opinion on the question; which acute trauma patient is in need of care by a Mobile Medical Team? In this paper we describe the protocol of the DENIM study (a Delphi-procedure on the identification of prehospital trauma patients in need of care by Mobile Medical Teams).

Airway obstruction due to aspiration of muddy water.

We report a case of complete airway obstruction due to aspiration of muddy water. An innovative approach to clear the airway is described, which may be a potentially life saving manoeuver in similar cases of suspected muddy water aspiration.

Helicopter Emergency Medical Services save lives: outcome in a cohort of 1073 polytraumatized patients.

Background: In many Western countries, Helicopter Emergency Medical Services (HEMS) have become standard in the prehospital care of severely injured patients. Several studies have shown that HEMS have a positive effect on patient's outcome, although it remains unclear which specific patients benefit most from its care. The aim of this study was to assess the effect of HEMS on the outcome of a large polytraumatized (Injury Severity Score≥16) population.

Criteria for cancelling helicopter emergency medical services (HEMS) dispatches.

Introduction: In The Netherlands there is no consensus about criteria for cancelling helicopter emergency medical services (HEMS) dispatches. This study assessed the ability of the primary HEMS dispatch criteria to identify major trauma patients. The predictive power of other early prehospital parameters was evaluated to design a safe triage model for HEMS dispatch cancellations.

Is a maximum Revised Trauma Score a safe triage tool for Helicopter Emergency Medical Services cancellations?

Introduction: The Revised Trauma Score is used worldwide in the prehospital setting and provides a snapshot of patient's physiological state. Several studies have shown that the reliability of the RTS is high in trauma outcomes. In the Netherlands, Helicopter Emergency Medical Services (HEMS) are mostly used for delivery of specialized trauma teams on-scene and occasionally for patient transportation.

Cancellations of (helicopter-transported) mobile medical team dispatches in the Netherlands.

Background: The trauma centre of the Trauma Center Region North-West Netherlands (TRNWN) has consensus criteria for Mobile Medical Team (MMT) scene dispatch. The MMT can be dispatched by the EMS-dispatch centre or by the on-scene ambulance crew and is transported by helicopter or ground transport. Although much attention has been paid to improve the dispatch criteria, the MMT is often cancelled after being dispatched.

The association of hemodilution and transfusion of red blood cells with biochemical markers of splanchnic and renal injury during cardiopulmonary bypass.

Background: Hemodilution is the main cause of a low hematocrit concentration during cardiopulmonary bypass. This low hematocrit may be insufficient for optimal tissue oxygen delivery and often results in packed cell transfusion. Our objective in this study was to find a relationship between intraoperative hematocrit and allogeneic blood transfusion on release of postoperative injury markers from the kidneys and the splanchnic area.

Evaluation of repatriation parameters: does medical history matter?

Background: Aeromedical repatriation of patients is an expanding service due to the growing number of travelers worldwide. Of these repatriated patients, a small number require specialized transportation due to severe medical complications. We evaluated the medical in-flight records of Dutch patients with severe disease or polytrauma who were repatriated by air from 1998 to 2002 via one of the largest Dutch alarm centers.

Cardiac response is greater for colloid than saline fluid loading after cardiac or vascular surgery.

Objective: To study the effects on volume expansion and myocardial function of colloids or crystalloids in the treatment of hypovolaemic hypotension after cardiac and major vascular surgery.

Design And Setting: A single-centre, single-blinded, randomized clinical trial at the intensive care unit of a university hospital.

Patients And Methods: Patients (n=67) were subjected to a 90-min filling pressure-guided fluid challenge with saline 0.

Percutaneous dilatational tracheostomy in the ICU: optimal organization, low complication rates, and description of a new complication.

Study Objectives: To assess short-term and long-term complications of bronchoscopy-guided, percutaneous dilatational tracheostomy (PDT) and surgical tracheostomy (ST) and to report a complication of PDT that has not been described previously.

Design: Prospective survey.

Setting: University teaching hospital.