Comparison of aeromedical crew performance by patient severity and outcome.
STUDY PURPOSE: One of the continuing controversies in aeromedical transport involves crew composition. Since 1987, we have used both physician/nurse (P/N) and nurse/nurse (N/N) crews to staff two identically equipped helicopter ambulances. The purpose of this study was to compare the severity of illness or injury and outcomes of patients transported by P/N and N/N crews. DESIGN: Retrospective cohort. METHODS: Data were obtained from the air ambulance and medical records of all aeromedical transfers between September 1, 1987, and August 31, 1988. Patients less than 16 years old or transferred to other hospitals were excluded. Severity of illness or injury was measured by Revised Trauma Score, APACHE-II, and Therapeutic Intervention Scoring System; outcome measures were mortality, and ICU and hospital lengths of stay. Patients were categorized as cardiac, trauma, or other. Origin of transfer (scene, emergency department, or hospital) and transfer times were included in the analysis. MEASUREMENTS AND MAIN RESULTS: Six hundred fifty-nine patients were studied--418 P/N and 241 N/N. No differences were found between P/N and N/N groups with regard to sex, Revised Trauma Score, APACHE-II, or Therapeutic Intervention Scoring System, although P/N patients were younger (45.7 versus 50.9 years, P = .001), included more cardiac (40% versus 36%) and trauma (38% versus 30%) patients (P = .002), and were more likely to have been transferred from an ED (68% versus 51%) or scene (7% versus 2%) (P = .001). Mortality, ICU length of stay, and hospital length of stay of P/N and N/N patients were not different, nor was time spent at the scene or hospital. Subgroup analysis did not alter these results. CONCLUSION: No objective differences in outcome of patients were found between P/N and N/N teams. Although small differences were found in types of flights taken by P/N and N/N teams, there were no differences in objective measures of severity between the two teams. We find no objective evidence to prefer one crew composition over another.