Epidemiology of Adverse Events in Air Medical Transport. Russell D. MacDonald, MD, MPH, Brie Ann Banks, BSc, MD, Merideth Morrison

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1 Egy Av Ev A M T R D. MD, MD, MPH, B A Bk, BS, MD, Mh M A Ojv: Th v y qy - v v gy g y. Mh: R y g y w vw g h w h y v- v- v v. Tw vw y v v gz h g h xy. Dv w v v, wh qy,000 gh,000 h w. R: Bw Jy, 2002, J 30, 2005, h w,447, whh 598 v v. C-g 25. A w v (94.%) v. Th w 58,956 gh 03,632 h w g h y,.53 v v,000 gh (95% CI v v) 6.56,000 h w (95% CI v v). Th q v y gy w w: (229; 33.7%), vh (43; 2.0%), q (88; 2.9%), g (77;.4%), (68; 0.0%), wh (30; 4.4%), (24; 3.5%), g h (2; 3.%). Th w h 7 v. C: A wh w v v h. C w h v. Dg v gy y y, h v v, v y. ACADEMIC EMERGECY MEDICIE 2008; 5: ª 2008 y h Sy A Egy M Kyw:,,, Th 999 I M (IOM) T E H hz h y hh F Rh Dv, Og T M (RDM, MM); h Dv Egy M (RDM) h Fy M (BAB), vy T, T, O, C. Rv My 5, 2008; v v J 30, 2008; Jy 7, P,, h A M T C, T, FL, S 8, 2007; h Hx 7: Th C Hh Sy Sy, Ow, O, C, O, Aw B S A h Hx 7: Th C Hh Sy Sy, Ow, O, C, O 3, D. MD h g h F A M Rh E V Z v h h. A : D. R D. MD; Th h gy (ED) h - v wh h h. Th, hwv, h gy v (EMS). I y, y v h v ED, w- v wh y v k. A ky hh h y h. 2 H yz v v, yz h EMS w. Th kwg g w 200, wh h Hghwy T Sy A (HTSA) EMS. 3 P hghgh h k EMS h h h g. Wh h g, y x h ª 2008 y h Sy A Egy M ISS : 0./j x PII ISS

2 924 MD. ADVERSE EVETS I AIR MEDICAL TRASPORT v y y. A vvg EMS y vy, g, wh, h, k. L EMS hgh, 4 8 h vg h j g 9 g z g y. Av v, hwv, h vy h w h w. Th,, hv vg g y v v g. T g k,, v y h g, y y v v v v. Av v g v y h, g. Iyg yzg v v y g y- h y v w h v y. By xg v v, y y y h v y. Th y h w jv. Th y jv h qy v v g g. Th y jv h gy v v h g g h gz h. METHODS Sy Dg W v v y y h qy v v h gy v v h g g h gz h. Th y w v y h Rh Eh B Syk Hh S C w wh h y h y Og T M O My Hh Lg-T C. Sy Sg P O g C v (xy. k 2 424,600 2 ) wh x,,,. Th hh y y v xy 2.5. Og T M h y y vg O. Og h A g g v, wh 33 - x-wg 26, yg xy 7,000 y. Og w h z gh y y. Th h hy vg - wh y h g. M hy gy (EM) hv xv EMS kg. Phy v, vg vgh h v qy, vg, hy, h,. Og h v, wh gh h v g. Th h hgh w g,, g wh q, h v, v, y g, - hy 0 wh. Th wh h O Cy P (OCP). Fgh v g g v v y h Og M Avy C hy wh h x h v. S 2002, h Og y Mg D g,, h y W- kh q,, v v. Th, h D S A (DSA), 2 z, kg wh h IOM. 3 P q y v v g g h DSA. A vg, v, vw. Th y v v Jy, 2002, J 30, Sy P W DSA v g h y h y y wh h h DSA vw T D Av Ev E A v v v y h g h. Av v h y y v. A v v v A g v v h,, x h h h gvy h hh qy. Ex h,, hg q g g. A y g g g v v A g v v h, w h. Ex q whh jy

3 ACAD EMERG MED O 2008, V. 5, v v T. I h v v k g g gh, w h v, v. I kh h v h gh wh h, w g v. R w x hy v v. T -g, w q h h v, v, y ( h ). R y y, y qy g h g v. Th qy y gh wh y, g h, h, wh v h k g (T 2). P gh, g vg h, v, hg, v (T 2), h v x h w x (M A, V 2002, M C., R, WA) vw. W v h g h. Tw h (RDM, BAB) y vw v y v v. W gz h v v g xy v v y (Fg ) h y v xy v y h J C A Hh Ogz (JCAHO). 4 W v g gg v v gz y, wh y h T 2 C-g C Iy A O Dy A y A y A y A y Dy g Dy Vh y Vh y Dy Dy Dy h Dy wh Dy h P x S ED y g P h C hg F g h ( ) h Dy g h ( ) h ED gy. Fg. P y v y xy v v. Oy j v. * h wh vw. P h v wh vw. (MM) y. Ev w gz h wh h h v h w j h jy v. Fg 2 h. O M Th y h qy v v. Th y h gz v v g h h. D Ay W gz v v, v g v. W h vw g h gz v v h g h k (j) h JCAHO j v h qy v v,000 gh,000 h w. Th y v v g h y. RESLTS Bw Jy, 2002, J 30, 2005, h w,447 W-, whh 598 v v. C-g h

4 926 MD. ADVERSE EVETS I AIR MEDICAL TRASPORT T 3 P Dgh Fgh Ch Ch P g M: 57.5% F: 42.3% Ag (y) M: 43.9 IR: 22, 64 Dg gy T: 8.3% C: 7.4% CS: 4.2% Ry: 8.8% Sh : 7.7% GI: 6.% O: 6.% Pyhy: 4.7% Oh: 6.9% Vh y Fx wg: 366 (53.8%) R wg: 27 (39.9%) L: 4 (0.6%) vh: 39 (5.7%) M gh Fx wg: 3.06 h R wg:.2 h Fgh y y* Dy ( h): 82.3% gh ( h: 7.7% Ev Y: 553 (8.3%) : 27 (8.7%) CS v y; GI g; IR q g. *T y wh gh g. Y: v wh w vg ; : v h w vg y. Fg 2. I v v. 25, 723 v v. Th y h (94.%) whh w v vw. Th w 58,956 gh 03,632 h w g h y. T 3 z h gh gh h h y. Th v v w.53,000 gh (95% v [CI] ), 6.56,000 h w (95% CI 6. 7.). Th v v, v, g 2.93, 8.9, 0.4,000 gh, vy. T 4 z h qy gz v v, g h, y v- v. Fg 3 k w v y wh h gy. Th vw g h v v (k 0.84; 95% CI ) h j JCAHO v h v v (j 0.66; 95% CI ). T 4 Fqy Cgz Av Ev (% T Ev) wh P H (% Cgy) T Av- T vh 43 2 q Wh 30 6 v- C M q 88 7 ( vy) P g C 68 6 P g h Th v v h (.99,000 gh). Th h v, v, g 0.3,.58, 0.0,000 gh, vy. Th vw g h h v (j 0.49; 95% CI 0.44

5 0.55). Fg 4 k w v y wh h gy. Th w 2 h g h y, whh w h yg. Th w g h y. Th x-wg, g k, h h w. DISCSSIO T kwg, h v y h - v v g - g. Th w.53 v v,000 gh, 6.56,000 h w. Wh h g h g,.5% (.53,000) Fg 3. Ev y wh h v. H P 7 C 9 2 I v - - g M P 0 2 q E M 7 & h V T q E 2 P C 6-9 M M - vy Lk g D g - h W 6 6 P h g 2 k - 2 A y v - h w - C y - 6 C - 6 h w O - 4 Fg 4. P h wh h v. ACAD EMERG MED O 2008, V. 5,

6 928 MD. ADVERSE EVETS I AIR MEDICAL TRASPORT h g.24% 5.3% h ED 5 8 h 3.7%.2% h 9, % v. 2 A v v g y w h -h g h h. Hwv, - v v - g 22 h h h - g. 23,24 W h h.99,000 gh, 7.3% v v. Th 4.7% v v g y h h ED. 20 My h y (0.04%) w ED- y 0.06%, 20 h g 0.5% 0.79% h h g. 6,7,9 Th v g v gz g v y gz (j ) 26,27 v y vw h hh g. Th v g h 0.49 g v (j ) 26,28 h. O wh h h jg v gz h g g h h v. Ev gz h jv w h y. W w kh, h h g y,, gh,, hy, vg y, wh h v v. C y g y kw,29,30 g v y y. 3 C y x h h g k w kh, y wh y wh h. O gg k gh. O gz zg h z y v xg hgy xhg w w v y. Oh h ghy, hghy, h h v y, z w g (CRM) g v y. CRM gz h h, wh q, h jy v. 32 Sy g w v v y, wh v gg v g. 33 Th hghy. Th CRM h hh g g, 34,35 y y y v. 36 I y, 45 (2.3%) v v w wh h g -kg. O h, (24.8%) h h, h hgh h. P 37 w k wh wkg g h g x k. 38 Cgv yh k g x, v-. 39 Hgh-y gz (HRO), h w h v y, y h y hgh-hz, hghk y Ry, g, g y hv y v h g y v HRO. Ahgh hh gz h gz, 4 h h y h v v y. 42 W h v q 43 gh. Ev q, h y. O gz g wh h x wh q g y hv h v gy. Ev v g h h, hwv,. 46,47 Wh h v g vy w h v gh (0.24%), h k wh h. Th IOM g g q v g g k h. Th v h y v g. Th y h v h h g. Th h g h hh g. Ky kg g y h y g v v v. 48 A g- y v x x yy,, v. Dvg xy y y v h g v g v gg v v. LIMITATIOS Th y gz v vy g gz h g h-. A - xy gz gh y v h gz vy, x. I, -g v y y g h w wh -g h. I h w h, h g h y w h v.

7 ACAD EMERG MED O 2008, V. 5, P yy gz, 49,50 h y h v v w. P y v v,, wh g q. Th y 25 v g -g h, whh 09 (87.2%) w v- wh- v y. I h x g h h y hv h y. A v v y wh h gg, h h v y h vg y. S y h v y w h w h v. Th w v v g. Th h y h v wh h g y. A v g y h y v v g h hy y h v v h. A y x wg h. Wh h w y v g w h, h g h h h w. Wh h, h vg, gh, v h v h y. Wh gy v v, v w wh v h k gh. Ex h wy h h, v g, v v wh. Th v wh- v h v gh g, wh gh w g. A v, g y gh y wh w v -v gg wh v v. Fy, h v y h gy x. Og wg h v 00,000 - yg h EMS, 5 h h xwg xgy w. Sy y h g h h v y. COCLSIOS W w v v h wh y. Th gy, h v v h g. Dg v gy y v y h g. F y v q y- xy y, h qy v v, v y. Th h hk gh Og T M Og x kh g v v g h vg. Th h hk D. Ch Mzz, P Ch Exv O, h B D Og T M h h h gg h v y. R. Kh FT, Cg JM, D MS. T E I H: Bg S Hh Sy. Whg, DC: A P, Bk GR, P. Mkg! Rg C hh. Hh P. 200; 2: Hghwy T Sy A. P Sy Egy M Sv. Whg, DC: HTSA, Lv A, Jh K. A h y vw. SA Ty J 4; S A:3(.3). 5. Lv A, Jh K. Sg h y. SA Ty J 7. Av : h://www.y./w// h_x.h. A J 7, Bk SP, Gwk JG, D RS, Shh DF, L MW, L GH. EMS h h: wh? A Eg M. 2006; 47: H J, Cky DG. Sy h A: v y. M J A. 2005; 82: B BE, Sh MG. M h h S: 0-y vw. J T. 2004; 56: T Sy B. Sy Sy C Egy M Sv H O. Jy 988; PB : TSB SS MD RD, Fqh S. T - - y. Ph Eg C. 2005; 9: P A C. O Cy P (OCP). Av : h://www../c.x?cid 4&CTyID2. A Ag 26, Og T M. D S A. Av : h://www.g./w q.h. A M 8, y Igy C Tk F. Dg Wh C P Sy: F A R M E Th I. R h P, Fy Av : h://www.q.gv/. A J 25, 2005.

8 930 MD. ADVERSE EVETS I AIR MEDICAL TRASPORT 4. Chg A, Shyv PM, C RJ, O Ly DS, L JM. Th JCAHO y v xy: z gy h v v. I J Hh C. 2005; 7: H J, S L, Sv MJ, Bhg G. Ex v v gy : v. Eg M A. 2007; 9: W RM, R WB, G RW, H BT, wy L, H JD. Th qy A hh y. M J A. 995; 63: L LL, B TY, L,. Th v v hz : h Hv P Sy II. Eg J M. 99; 324: W AM, Bk J. Dg g v v A h gy g g vw. Eg M J. 2002; 9: B TA, L LL, L M,. I v v gg hz : h Hv M P Sy I. S Hh C. 2004; 3: Dv P, Ly-Y R, B R, A W, S A, Shg S. Av v w Z h I:. Z M J. 2002; 5: Rhh JM, Lg CP, C JW,. Th C C Sy Sy: h v v v. C C M. 2005; 33: Sgh JM, MD RD, Bk SE, Sh MJ. Iy y- : - v. A J R C C M. 2007; 75( ): Fy GP, S MJ, R JJ. Th g : q v. Ah. 998; 53: Dwh AT, F D, Wk C, M P, Bv P, G JC. M v x-wg : vw h v v. Ah. 200; 56: L JR, Kh GG. Th v g g. B. 977; 33: K DL, Rh DM, Ky J, A C, W SM. I- - y v. S Hh C. 2006; 5: Kg WJ, P, Rgj J, F GJ, Swz R. Th z hy y v g v. P. 2003; 2(3 P ): Gwx JH, F TS, Av J,. I vy v g v g h. A J M. 2000; 09: S KR, Kx GE. Av : gzg, g, vg y. AWHO L. 2003; 7: E g : v y h g. S Hh C. 2003; 2: J C A Hh Ogz. Pvg h jy g vy. S Ev A. 2004; 30: Hh RL. O g: v. BMJ. 2000; 320: S RJ, S E, Fwk JE. Ehg wk x v hgh g. G Dy: Th R P. 997; : R DT, R MM, Sy ML, S R, Jy GD, B SD. Th v wk h gy. A Eg M. 999; 34: Gg EL, S RA, F DJ,. Th v- wk g h hh-. J A C Sg. 2004; 99: Th EJ, Hh RL. W y wk. : Rh MM, S KM (). M E: Wh D W Kw? Wh D W D? S F, CA: Jy-B, 2002, R J, Myk K. A-? Th yhgy vyy. Egw C, J: P H, L L. E. JAMA. 994; 272: J C A Hh Ogz. I v: vg g v. Okk, IL: JCAHO, R K. S h hgh-y gz. Ogz S. 990; : G DM. S gz y: hh h hgh-hz. C Mg Rv. 2000; 43: Ph K. Th w hh : g. Okk, IL: JCAHO, Sh I, Fg S, C A. Mh g h v. C C M. 990; 8: H JM, Dv K J, Jh DJ, B RD, C RS, B PS. C g -h y : v h y. J T. 992; 33: G L, L G, W T, Fw K, B R, MG V. Av v x wh g h y h gy h v. Eg M J. 2006; 23: Rh KJ, H EM, Mk HP, Th FO. A gy h h S h F R Gy. Av S Ev M. 990; 6: H J, Cky DG. Sy h A: v y. M J A. 2005; 82:7 9.

9 ACAD EMERG MED O 2008, V. 5, L LL, Bwk DM. Fv y T E H : wh hv w? JAMA. 2005; 293: Hg C, X J, W B, Hk J. E,, g: h gy v y. A Eg M. 2004; : Hg C, B Bw J, B JH, Ovy B, Ty-Sv JH. D EMS y,,? Ph Eg C. 2006; 0: C H. EMS Fgh Sy. A Av : h://www.h. //_2.h. A D 7, 2006.

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