Is helicopter evacuation effective in rural trauma transport?

Helicopter transport for trauma remains controversial because its appropriate utilization and efficacy with regard to improved survival is unproven. The purpose of this study was to assess rural trauma helicopter transport utilization and effect on patient survival. A retrospective chart review over a 2-year period (2007-2008) was performed of all rural helicopter and ground ambulance trauma patient transports to an urban Level I trauma center. Data was collected with regard to patient mortality and Injury Severity Score (ISS). Miles to the Level I trauma center were calculated from the point where helicopter or ground ambulance transport services initiated contact with the patient to the Level I trauma center. During the 2-year period, 1443 rural trauma patients were transported by ground ambulance and 1028 rural trauma patients were transported by helicopter. Of the patients with ISS of 0 to 10, 471 patients were transported by helicopter and 1039 transported by ground. There were 465 (99%) survivors with ISS 0 to 10 transported by helicopter with an average transport distance of 34.6 miles versus 1034 (99.5%) survivors with ISS 0 to 10 who were transported by ground an average of 41.0 miles. Four hundred and twenty-one patients with ISS 11 to 30 were transported by helicopter an average of 33.3 miles with 367 (87%) survivors versus a 95 per cent survival in 352 patients with ISS 11 to 30 who were transported by ground an average of 39.9 miles. One hundred and thirty-six patients with ISS > 30 were transported by helicopter an average of 32.8 miles with 78 (57%) survivors versus a 69 per cent survival in 52 patients with ISS > 30 who were transported by ground an average of 33.0 miles. Helicopter transport does not seem to improve survival in severely injured (ISS > 30) patients. Helicopter transport does not improve survival and is associated with shorter travel distances in less severely injured (ISS < 10) patients in rural areas. This data questions effective helicopter utilization for trauma patients in rural areas. Further study with regard to helicopter transport effect on patient survival and cost-effective utilization is warranted.

Effect of systemic doxycycline on alveolar bone loss after periradicular surgery.

Studies in the periodontic literature have shown an average of 0.5 mm to > 1.0 mm of bone loss after full thickness flap reflection. Similar literature has revealed that the tetracycline family of antibiotics can prevent bone loss. The purpose of this study was to observe the effect of systemic Doxycycline on crestal alveolar bone loss after periradicular surgery in beagle dogs. Five beagle dogs were used in two phases of this study. In the first phase (control sides), after reflecting full thickness flaps in one mandibular quadrant, notches were placed in the enamel of the third and fourth premolar teeth using a one-quarter round bur. Using magnification, measurements were taken from the reference notches to the height of the alveolar crest. After 8 wk, flaps were reflected in the same quadrant and measurements retaken, and the amount of bone loss was then measured. In the second phase (experimental sides), the same procedure was performed on the contralateral mandibular quadrant, but the dogs were placed on 4.4 mg/kg/day of Doxycycline for 10 days after reflections of full thickness flaps. After another 8 wk, the area was reflapped and measured. There was significantly (p < 0.01) less bone loss on the Doxycycline-treated side.