Finger thoracostomy in patients with chest trauma performed by paramedics on a helicopter emergency medical service.

Abstract

OBJECTIVE:

To determine the frequency of finger thoracostomy performed by intensive care flight paramedics after the introduction of a training programme in this procedure and complications of the procedure that were diagnosed after hospital arrival.

METHODS:

This was a retrospective cohort study of adult and paediatric trauma patients undergoing finger thoracostomy performed by paramedics on a helicopter emergency medical service between June 2015 and May 2018. Hospital data were obtained through a manual search of the medical records at each of the three receiving major trauma services. Additional data were sourced from the Victorian State Trauma Registry.

RESULTS:

The final analysis included 103 cases, of which 73.8% underwent bilateral procedures with a total of 179 finger thoracostomies performed. The mean age of patients was 42.8 (standard deviation 21.4) years and 73.8% were male. Motor vehicle collision was the most common mechanism of injury accounting for 54.4% of cases. The median Injury Severity Score was 41 (interquartile range 29-54). There were 30 patients who died pre-hospital, with most (n = 25) having finger thoracostomy performed in the setting of a traumatic cardiac arrest. A supine chest X-ray was performed prior to intercostal catheter insertion in 38 of 73 patients arriving at hospital; of these, none demonstrated a tension pneumothorax. There were three cases of potential complications related to the finger thoracostomy.

CONCLUSION:

Finger thoracostomy was frequently performed by intensive care flight paramedics. It was associated with a low rate of major complications and given the deficiencies of needle thoracostomy, should be the preferred approach for chest decompression.

• Authors: Liam Hannon, Toby St Clair, Karen Smith, Mark Fitzgerald, Biswadev Mitra, Alexander Olaussen, John Moloney, George Braitberg, Rodney Judson, Warwick Teague, Nuala Quinn, Yesul Kim, Stephen Bernard
• Journal: Emergency medicine Australasia : EMA (Emerg Med Australas) Vol. 32 Issue 4 Pg. 650-656 (08 2020) ISSN: 1742-6723 [Electronic] Australia
• PMID: 32564497 (Publication Type: Journal Article)
• Copyright: © 2020 Australasian College for Emergency Medicine.

Topics

• Adult
• Aircraft
• Allied Health Personnel
• Child
• Emergency Medical Services
• Humans
• Male
• Pneumothorax (epidemiology, etiology, surgery)
• Retrospective Studies
• Thoracostomy
• Young Adult