Helicopter Hoist Operations in Difficult Nonalpine Terrain

Abstract

ObjectiveHelicopter hoist operations (HHOs) are an option for rescue in difficult- or impossible-to-access environments. At present, only a few helicopters in German helicopter emergency medical services have a hoist capability; most of them are located in the Bavarian Alps. We sought to study the demand for hoist operations in difficult terrain outside of alpine regions. MethodsThe setting for this study was a city borough between the Rhine valley and the Black Forest (Germany). We retrospectively studied all rescue operations in difficult terrain from January 1, 2007, to July 31, 2018. The characteristics of the terrain and operational, demographic, and medical aspects were analyzed. The predictors for a prolonged response time and the total prehospital time were identified by multivariate regression analysis. In addition, a simulation study creating time intervals for the alternative rescue procedure (ground vs. hoist) was performed. Operational data for the simulation were taken from an expert survey as well as field data collection in the course of HHO training. ResultsA total of 251 missions were included. Patients were predominantly male (66.7%) adults (57.5%) with traumatic lesions (75.0%); 14.1% had severe or multiple injuries, 4.7% had life-threatening medical conditions, and 4.3% were deceased. Two hundred eight patients (93%) were rescued by ground procedures. The prehospital time of HHO missions was significantly longer (104 vs. 72 minutes, P < .001). However, the simulation of all missions showed a significantly shorter prehospital time with 80 versus 91 minutes (P < .001) for rescue by HHOs. The predictors for prolonged prehospital times were a vague description of the accident site, difficult terrain, distance from the road, slope gradient, and life-threatening nontraumatic conditions of the patient. ConclusionWe found a significant benefit of hoist operations regarding the total prehospital time and admission to an appropriate trauma center. Consistent dispatch procedures for HHO missions can improve patient outcomes. Adding HHO capabilities to some selected helicopter emergency medical service helicopters should be considered.