Abstract
Patients with acute myocardial infarction (AMI) or acute trauma (AT) are transported by air to save time. Helicopter Emergency Medical Service (HEMS) provides both flights to and from the emergency scene, as well as interhospital transport (interHtransport). The objective of this study was to compare aeromedical transport and HEMS missions of AMI and AT patients regarding safety, medical procedures and the length of flights. This is a case-control study analyzing the medical history records of AMI and AT patients transported between hospitals and from the scene identified using ICD-10 codes. Research of customary data (age, sex and general health status measured with Glasgow Coma Scale (GCS) and Revised Trauma Score (RTS)) was performed. There were 48,555 flights in the years 2011-2016, of which 7,645 (15.7%) were interhospital (19% AMI and 12% AT). Out of these, 40,910 (84.3%) HEMS missions were to patients on the scene (10% AMI and 13% AT). No fatalities were noted. The AMI GCS score was higher than in AT patients: 15.0 vs 14.0, respectively. The medical procedures during transport of AMI patients between hospitals and from the scene were the following: cardiopulmonary resuscitation (CPR): 6 vs 73 cases (p < 0.001); oxygen therapy: 41.1% vs 50.2%, respectively. The median distance was 59.4 km vs 52.1 km (p < 0.001), while median flight time was 45.0 min vs 38.0 min (p < 0.001), respectively. Regarding AT patients, the procedures performed (during interhospital and from the scene transport) were the following: CPR: 5 vs 244 cases (p < 0.001); intubation: 10.7% vs 17.3% (p < 0.001); sedation: 50.1% vs 24.3% (p < 0.001); oxygen therapy: 17.6% vs 36.6% (p < 0.001); spinal board: 17.1% vs 66% (p < 0.001); cervical collar: 15.9% vs 63.4% (p < 0.001), respectively. Interhospital transport and HEMS mission median flight distance was 135.9 km vs 56.3 km (p < 0.001), while median flight time was 66.0 min vs 45.0 min (p < 0.001), respectively. Aeromedical transport is safe and very rarely requires resuscitation during the flight. The long distances of flights and time required can reflect the scarcity of trauma centers (TCs) compared to cardiovascular wards. The location of hemodynamic centers in Poland is optimal.
Highlights
To the rest of the world, in Poland aeromedical interhospital transport in the rescue mode is the most frequent form of transporting both patients with acute trauma (AT) and with acute myocardial infarction (AMI).[1,2] The Medical Air Rescue Service (MARS) has at its disposal 2 kinds of aircraft: 22 EC 135 2+ and H135 P3 helicopters, forming the Helicopter Emergency Medical Service (HEMS)
40,910 (84.3%) HEMS missions were to patients on the scene (10% AMI and 13% AT)
The long distances of flights and time required can reflect the scarcity of trauma centers (TCs) compared to cardiovascular wards
Summary
To the rest of the world, in Poland aeromedical interhospital transport (interHtransport) in the rescue mode is the most frequent form of transporting both patients with acute trauma (AT) and with acute myocardial infarction (AMI).[1,2] The Medical Air Rescue Service (MARS) has at its disposal 2 kinds of aircraft: 22 EC 135 2+ and H135 P3 helicopters, forming the Helicopter Emergency Medical Service (HEMS). It is essential to transport the AMI patient in a sudden critical health condition who requires intensive supervision during the flight to a hospital which has a hemodynamics department, so that percutaneous coronary intervention (PCI) can be carried out.[1,3] The responsibility for the organization and choice of transport mode between an ambulance and a helicopter falls on the dispatching doctor who is in charge of the patient. Helicopter Emergency Medical Service (HEMS) provides both flights to and from the emergency scene, as well as interhospital transport (interHtransport)
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