[Extended medical quality management exemplified by the tracer diagnosis multiple trauma. Pilot study in the air rescue service]

Adequate prehospital and inhospital primary care is a decisive factor in the successful treatment of multiple trauma patients. For optimization of treatment algorithms the implementation of a medical quality management is of utmost importance. The aim of this study was to extend quality management by including data on process quality.A retrospective study of primary rescue missions of the Helicopter Emergency Medical Service (HEMS) Christoph 22 in Ulm over a period of 2.5 years was performed. In a detailed analysis of filter criteria, in which relevant deviations from the recommendations (not fulfilled in 10% of the cases) occurred, process data was included (vital data, measurements and events).In the study population (n = 298, males 71.8%, mean age 39.8 ± 21.8 years) 2 filter criteria were identified in which relevant deviations where observed: time management where prehospital treatment time ≤ 60 min in 36% of the cases was not fulfilled and circulatory management where the systolic blood pressure, detected with Riva-Rocci method (RR(sys)) ≥ 120 mmHg on hospital admission in patients with severe head trauma was not fulfilled in 45% of the cases. In patients with deviations in time management, prehospital treatment time was prolonged (75.6 ± 18.3 min versus 50.5 ± 6.7 min; p0.01) caused by a prolonged on scene attendance time (34.1 ± 22.1 min versus 20.6 ± 9.2 min; p0.01) and transport time (17.3 ± 9.4 min versus 13.3 ± 4.8 min; p0.01). In entrapment trauma prehospital treatment time was expanded (44% versus 10%; p0.01). Patients in whom circulatory management deviations were observed were more often in shock on arrival at the scene (RR(sys) ≤ 90 mmHg: 60% versus 30%; p0.01), more often hypoxemic [pulse oximeter oxygen saturation (S(p)O(2)) ≤ 90%: 36% versus 19%; p0.05] and more often sustained a trauma to the chest as well as to chest and abdomen/pelvis (69% versus 52% and 42% versus 28%, respectively; p0.05). Furthermore, the infusion volume of colloids was higher (1241 ± 810 ml versus 753 ± 359 ml; p0.05) and the combined usage of small volume resuscitation and catecholamines was more often necessary (42% versus 25%; p0.05).Including process data of prehospital mission data recording facilitates an extended medical quality management.