Treatment, transport, and primary care involvement when helicopter emergency medical services are inaccessible: a retrospective study

Dag Ståle Nystøyl,Steinar Hunskaar,Hans Johan Breidablik,Øyvind Østerås,Erik Zakariassen

doi:10.1080/02813432.2018.1523992

Abstract

Objective: To examine handling of cancelled helicopter emergency medical services (HEMS) missions with a persisting medical indication.Design: Retrospective observational study.Setting and subjects: Cancelled HEMS missions with persisting medical indication within Sogn og Fjordane county in Norway during the period of 2010–2013. Both primary and secondary missions were included.Main outcome measures: Primary care involvement, treatment and cooperation within the prehospital system.Results: Our analysis included 172 missions with 180 patients. Two-thirds of the patients (118/180) were from primary missions. In 95% (112/118) of primary missions, GPs were alerted, and they examined 62% (70/112) of these patients. Among the patients examined by a GP, 30% (21/70) were accompanied by a GP during transport to hospital. GP involvement did not differ according to time of day (p = 0.601), diagnostic group (p = 0.309), or patient’s age (p = 0.409). In 41% of primary missions, the patients received no treatment or oxygen only during transport. Among the secondary missions, 10% (6/62) of patients were intubated or received non-invasive ventilation and were accompanied by a physician or nurse anaesthetist during transport.Conclusions: Ambulance workers and GPs have an important role when HEMS is unavailable. Our findings indicated good collaboration among the prehospital personnel. Many of the patients were provided minimal or no treatment, and treatment did not differ according to GP involvement.Key PointsKnowledge about handling and involvement of prehospital services in cancelled helicopter emergency medical services (HEMS) missions are scarce.Ambulance workers and general practitioners have an important role when HEMS is unavailableMinimal or no treatment was given to a large amount of the patients, regardless of which health personnel who encountered the patient.

Highlights

On-call general practitioners (GPs) and the ambulance service constitute the backbone of the pre-hospital emergency medical service (EMS) in Norway
We investigated helicopter emergency medical services (HEMS) missions that were cancelled for non-medical reasons, with the aims of determining the extent of primary care involvement, the treatment provided, and the cooperation between the prehospital services
73% (455/627) were excluded from our analysis because the missions were completed by neighboring HEMS (33%), there was no longer medical indication for HEMS (20%), or other reasons, such as misclassification or duplicates (20%)

Summary

Introduction

On-call general practitioners (GPs) and the ambulance service constitute the backbone of the pre-hospital emergency medical service (EMS) in Norway. GPs regularly complete re-training in emergency medicine. Ambulance workers complete at least two years of upper secondary school and two years as an apprentice [1]. Every municipality in Norway is obligated to have a doctor on call around the clock, who can potentially call out immediately in emergencies [2]. GPs and the ambulance service handle the majority of medical emergencies without requiring helicopter emergency medical services (HEMS). Involvement of GPs in emergency patients differs between European countries, i.e. Denmark where GPs perform telephone

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