Primary aeromedical retrieval crew composition: Do different teams impact clinical outcomes? A descriptive systematic...

Area of Science:

• Emergency Medicine
• Trauma Care
• Aeromedical Evacuation

Background:

• Primary aeromedical retrieval missions, including military forward aeromedical evacuation and civilian Helicopter Emergency Medical Services, have variable crew compositions.
• The optimal crew composition for these critical missions remains undetermined.

Purpose of the Study:

• To conduct a descriptive systematic review examining mortality and other outcomes associated with different crew compositions in primary aeromedical retrieval.

Main Methods:

• Systematic review of Medline, Embase, and Cochrane databases up to January 2020.
• Inclusion of studies on adult trauma patients transported by air with varying crew compositions.
• Abstraction of data on population, injury severity, crew, procedures, and outcomes; risk of bias assessment.

Main Results:

• Sixteen studies (3 prospective, 1 case-control, 12 retrospective) met inclusion criteria.
• A mortality benefit was observed with advanced healthcare providers, particularly for severe but survivable injuries.
• Interventions like rapid sequence induction and blood product transfusion were better performed by advanced providers, potentially improving outcomes.

Conclusions:

• A trend towards decreased mortality was noted in patients treated by advanced providers, especially those with severe injuries.
• Findings suggest advanced providers may improve outcomes, but results require cautious interpretation due to observational study limitations and potential confounding factors.