60 | MEDICAL CARE Fig. 4: The Mil Mi-8, or Mi-17, a legendary Russian helicopter, is a reliable and an undemanding medium twinturbine helicopter, suitable for military and emergency ops, but too large and expensive to transport 1 to 2 patients Table 4: Types of treatment in helicopter Table 5: Treatment in specialist paediatric hospital We found statistically significant differences between groups according to the results of the clinical assessment of degree of severity on admission to the hospital (χ2=91.3, df=4, p<0.001). In the majority of cases (78.3%), the degree of severity of children delivered to the hospital from the accident site (group A) was assessed as minor or moderate. Of those children transferred from the accident site by helicopter, 2 had no traumatic injuries and 17 had superficial scratches. Overall, children with minimal or no traumatic injuries made up 10.6% of group A. Indirect confirmation of a relatively high proportion of children with minimal injuries among those delivered from the accident site was the fact that 4 children were allowed to return home following the examination and 19 children refused hospitalisation. In total, this represented one fifth (21.7%) of all children in group A. The status of the vast majority (93.2%) of children in group B was classed as severe, critical or terminal. Half the children undergoing inter-hospital transfer were estimated as having either critical or terminal status. This situation was the result of a preliminary triage of patients who were first transferred from the accident site to local municipal hospitals and then those who needed interhospital transfer being classed as requiring specialised (including high technology) medical care. In group B, only 6.8% of patients were classed as having moderate severity. Group A (n=106) Group B (n=74) χ2 p 52.7 40.7 p<0.001 67 90.5 34.0 p<0.001 70 94.6 61.9 p<0.001 77.0 60.2 p<0.001 absolute % absolute % Mechanical ventilation 10 9.4 39 Oxygen therapy 51 48.1 Infusion therapy 38 35.8 Type of treatment Treatment in specialist paediatric hospital (level 1 trauma center) ICU admission 20 18.9 57 Surgical intervention 24 22.6 63 85.1 68.1 p<0.001 Fatality 3 2.8 8 10.8 4.84 p=0.028 Type of traumatic injury is shown in Table 2. In group A, two thirds of all injuries were isolated. Mainly, these were head traumas with varying degrees of severity. In group B, children with polytrauma prevailed (87.8%). Two children were delivered with combined injury types: mechanical trauma and thermal burns. The prevalence of isolated injuries in group A is statistically significant (χ2=51.4, df=1, p<0.001). Clinical symptoms of traumatic shock were diagnosed in 51 children from group B, which represents more than two thirds (68.9%), and in just 18 children from group A, or one sixth of the group (17.0%). The difference in the frequency of shock development between the groups was also significant (χ2=49.7, df=1, p<0.001). The ratio of chances of developing shock among children in group B was 10.7 times higher than among those who were delivered directly from the accident site (considering 95% confidence interval – 5.32, 22.1). An assessment of injury severity according to the Injury Severity Score (ISS) gave the number of children with a score of more than 15 as 10 (9.4%) in group A, and 64 (86.5%) in group B. We have shown the significant difference between the groups in the number of children with severe traumas (χ2=106.9; df=1; p<0.001). The majority of children evacuated by air from medical institutions in the Moscow region were suffering from severe traumas (assessed as scoring over 15 on the ISS scale). In absolute values, trauma severity scores on the ISS scale in group A were 4.0 (median), 4.0–8.0 (25–75% percentile) and 0.0–43.0 (min–max). Scores in group B were 29.0, 20.0–41.0 and 6.0–59.0. There was a strong correlation between the clinical assessment of the degree of severity and the trauma severity score on the ISS scale (Spearman correlation coefficient r=0.86, t(n-2)=22.5, p<0.001, n=180). In accordance with the definition of the German Society of Emergency Surgery, traumas may be assessed as “polytrauma” (i.e. wounds affecting more than one part of the body simultaneously) when any one of these wounds or a combination thereof threatens the life and health of a patient (5). A similar situation was observed in a comparative assessment of injury severity using the PTS (Hanover Polytrauma Score). Table 3 shows that the degree of severity of almost two thirds of patients in group B corresponded to level 2–4, compared with just 7.5% in group A. The difference between the groups was statistically significant (χ2 =70.2, df=4, p<0.001). The difference in the severity of the initial status of patients injured in road accidents was reflected in the degree of use of medical treatment such as mechanical ventilation, oxygen and infusion therapy during air evacuation. Table 4 shows significant differences between the groups in this regard, which can be explained by the severity of the status of children transferred from municipal medical institutions in the Moscow region following primary triage, measured by the severity of their injuries and the assessment of the need to continue their treatment in a specialist paediatric hospital. Treatment administered to patients in a paediatric surgical hospital is shown in Table 5. Patients transferred 1 · 2013 I Vol. 3 I AirRescue I 60