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Background: Patients suffering head injury in remote islands of Taiwan, which have a shortage of manpower and facilities, depend on EAMS for prompt and definitive treatment. Emergency air medical services are becoming an increasingly important issue in improving the quality of primary care and avoiding medicolegal problems. The purpose of this study was to investigate the characteristics of patients with head injury and use of EAMS., Methods: We reviewed all patients, especially head injury transported by air ambulance from a remote island, Kinmen (400 km from Taiwan Main Island), from January 2001 to December 2003. Data were collected with regard to demographics, disease classification, mechanism of injury, severity of head injury, ventilator use, and mortality rate., Results: A total of 215 patients were transferred, of whom 57 (27%) had head injury. The mean age of patients was 48.6 +/- 23.8 years. Males accounted for 72% of the cases (male/female ratio, 2.6:1). Motor-vehicle accidents were the most common mechanism of injury (68%). There were 21 (37%), 20 (35%), and 16 (28%) patients in the minor, moderate, and severe head-injury groups, respectively. Nineteen patients (33%) received mechanical ventilation. The overall mortality rate was 14 % (8/57). In the severe head-injury group, the mortality rate was 44% (7/16)., Conclusions: The higher incidence of head injury (26.5%) in EAMS than in ground transportation (19.8%) suggests that preflight assessment and in-flight management of patients conducted by an experienced escort team following guidelines for head injury in EAMS are a very important issue.

Background: Data pertaining to head injuries in adolescents in Taiwan are scarce. The purpose of this study was to investigate the trend and pattern of head injuries in adolescents in both urban and rural areas in Taiwan., Methods: We collected data from major hospitals in the urban (20) and in the rural (4) areas of Taiwan for a period of 3 years. Data were obtained from the Head Injury Registry, a 10-year electronic database of head injury in Taiwan. The inpatient medical records of adolescents with head injury were thoroughly reviewed. Severity of head injury was classified by the GCS score, and patient outcome at discharge from hospital was measured by the Glasgow Outcome Scale. Differences and correlation between study groups (13-15 and 16-18 years old) in the urban and rural areas were examined using 2-tailed t and chi(2) tests., Results: A total of 469 head injury cases in the urban area and 131 in the rural area were identified. Traffic accidents were the major cause of head injury, and motorcycles were the most predominant vehicles causing traffic accidents in both urban and rural areas. Intracranial hemorrhages were the most prevalent injury pattern in the study population. In both urban and rural areas, the severities of injury were not significantly different (P=.184), but the outcomes at discharge were significantly better in urban areas (P=.032). The correlation between the initial GCS and outcomes in both areas was significant (P<.001). Craniotomy was performed more frequently in the rural area than in the urban area (15.3% vs 7.2%). The mean hospital stay was shorter in the latter than in the former (P<.001). Education on helmet use, input of neurosurgical staff, and facility and emergency medical transportation service of head-injured patients following guidelines proposed by the WFNS are crucial for head injury and better control in rural areas., Conclusions: The causes, patterns, and outcomes of head injury were statistically different between the 2 age groups of adolescents in urban and rural areas. Further studies on adolescent head injury are necessary.