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There is debate within the emergency medical services (EMS) community over the value of calling a helicopter for trauma patients within a moderate distance/45 min, of a trauma center. Helicopter EMS (HEMS) generally have a wider scope and more advanced training than the ground EMS (GEMS). GEMS, on the other hand, have the benefit of being able to immediately initiate rapid transport to the trauma center without the delay involved with HEMS flying to the scene, landing, and assuming patient care.We retrospectively analyzed patients brought to a level I trauma center who were admitted with blunt traumatic injuries between 2010 and 2015 in the Trauma Quality Improvement Program database. Two analyses were performed, one in which the patient's reported initial scene vitals met criteria for step one of the Centers for Disease Control's 2011 National Field Triage Guidelines (NFTG) and the other in which the patient's initial scene vitals met those same guidelines and/or had a pulse greater than 110 beats per minute. Patients were categorized on scene to emergency department (ED) transport mode, either HEMS or GEMS. Inclusion criteria were a HEMS response time to the scene that was between 15 and 45 min with a transport time from the scene to the ED that was between 10 and 35 min or a GEMS transport time from the scene to the ED that was between 15 and 45 min. Statistical significance (P 0.05) was established through logit regression. Mortality rates were then calculated within each transport mode-based population.Four hundred subjects were included in the analysis of patients meeting the first step of the NFTG, with 212 HEMS patients and 188 in the GEMS group. HEMS had a higher mortality rate at 0.184 and GEMS at 0.101, which was statistically significant (P = 0.019). When 606 subjects meeting the first step of the NFTG or with a pulse greater than 110 beats per minute were analyzed, the results were statistically significant (P 0.001), with the HEMS category having a higher mortality rate at 0.154 and the GEMS category having a lower mortality at 0.056.Our data demonstrate that scene-to-ED time is paramount, and rapid ground transport should be used in blunt trauma patients when the scene is up to a moderate ground distance away from the trauma center and there would be a moderate-to-prolonged HEMS response time. In both analyses, hemodynamically unstable trauma patients had lower rates of mortality following ground transport. We recognize that there may be a subset of patients at these distances who could benefit from HEMS response, particularly if the flight crew can offer more advanced and specialized techniques; however, every effort should be made to minimize the scene-to-ED time, and HEMS response, scene, and transport time must be considered. This study only analyzed the patients within a moderate distance of the trauma center and at longer distances or in different environments; HEMS transport may indeed minimize the scene to ED time.

Enteral nutrition with eicosapentaenoic acid (EPA; 20:5 n-3) and gamma-linolenic acid (GLA; 18:3 n-6) decreased pulmonary inflammation by reducing neutrophil counts and chemotactic factors in bronchoalveolar lavage fluid during acute respiratory distress syndrome (ARDS). We hypothesize that the anti-inflammatory effects of EPA and GLA may be due, in part, to induction of neutrophil apoptosis. The purpose of this study was to determine whether EPA and GLA, alone or in combination, trigger apoptotic cell death in the human promyelocytic leukemia HL-60 cell line. HL-60 cells were incubated with 10, 20, 50, and 100 micromol/L EPA, GLA, or various combinations of EPA and GLA for 2, 4, 8, 12, and 24 hs. Oleic acid (18:1 n-9) was used as a fatty acid control. Flow cytometry using dual staining with propidium iodide and annexin V-FITC assessed apoptosis, necrosis, and viability. Apoptosis was verified by DNA fragmentation as assessed by agarose gel electrophoresis. EPA, GLA, and various combinations of EPA and GLA significantly induced apoptosis and reduced cell viability in HL-60 cells. Viability was significantly reduced to the same extent with the combination of 50 micromol/L EPA\20 micromol/L GLA compared with 100 micromol/L EPA. These data indicate that EPA and GLA, alone or in combination, reduce cell survival by induction of apoptosis. Thus, induction of apoptosis by select dietary n-3 (EPA) and n-6 (GLA) polyunsaturated fatty acids may be the mechanism of the resolution of pulmonary inflammation in ARDS.

Background. Multiple studies support the nonoperative management (NOM) of blunt liver injury (BLI). Hemodynamically unstable patients remain a clear-cut indication for operative management. This study elucidates the failure rate of NOM as well as the etiology of unsuccessful NOM. Methods. A retrospective chart review of 538 trauma admissions with documented BLI was conducted at a level I trauma center. BLI was classified according to the AAST Organ Injury Scale. Variables included were age, grade of the liver injury, associated organ injuries, injury severity scale, transfusion requirement, and the need for exploratory laparotomy. Laparotomy was defined as delayed when patient needed operation after departure from the emergency department. Delayed exploratory laparotomy was considered a failure of NOM when surgery was performed to control liver hemorrhage. Results. Mean age was 35 years; 55% were men. Mean BLI grade was 2.4 and ISS was 23. Thirty-six percent had other associated intraabdominal injury. Of the 538 patients, only 102 (19%) went to operation and 20 were delayed. Of these, 18 patients had other injuries as primary cause for exploration (spleen, hollow viscus, abdominal compartment syndrome, etc.). Only two patients (0.005%) failed NOM; both had Grade V injury and both required surgery within 4 h from admission. Conclusion. The success rate of NOM in the stable patient with BLI is nearly 100%. Heightened care should be emphasized on patients with other intraabdominal injury or large fluid resuscitation who may fail NOM.