Emergency Medical Service Helicopter Research Articles

Use of the Airtraq laryngoscope for emergency intubation in the prehospital setting: A randomized control trial*

The optical Airtraq laryngoscope (Prodol Meditec, Vizcaya, Spain) has been shown to have advantages when compared with direct laryngoscopy in difficult airway patients. Furthermore, it has been suggested that it is easy to use and handle even for inexperienced advanced life support providers. As such, we sought to assess whether the Airtraq may be a reliable alternative to conventional intubation when used in the prehospital setting. Prospective, randomized control trial in emergency patients requiring endotracheal intubation provided by anesthesiologists or emergency physicians responding with an emergency medical service helicopter or ground unit associated with the Department of Anesthesiology, General Hospital, Wiener Neustadt, Austria. During the 18-month study period, 212 patients were enrolled. When the Airtraq was used as first-line airway device (n=106) vs. direct laryngoscopy (n=106), success rate was 47% vs. 99%, respectively (p<.001). Reasons for failed Airtraq intubation were related to the fiber-optic characteristic of this device (i.e., impaired sight due to blood and vomitus, n=11) or to assumed handling problems (i.e., cuff damage, tube misplacement, or inappropriate visualization of the glottis, n=24). In 54 of 56 patients where Airtraq intubation failed, direct laryngoscopy was successful on the first attempt; in the remaining two and in one additional case of failed direct laryngoscopy, the airway was finally secured employing the Fastrach laryngeal mask. There was no correlation between success rates and body mass index, age, indication for airway management, emergency medical service unit, or experience of the physicians. Based on these results, the use of the Airtraq laryngoscope as a primary airway device cannot be recommended in the prehospital setting without significant clinical experience obtained in the operation room. We conclude that the clinical learning process of the Airtraq laryngoscope is much longer than reported in the anesthesia literature.

Investigation of final destination hospitals for patients in helicopter emergency medical services (doctor–helicopter) in Fukushima Prefecture

In using an emergency medical service helicopter with an emergency medicine doctor on board (doctor-helicopter), transporting all patients to the University Hospital (base hospital for the helicopter) could cause a chronic bed shortage at the University Hospital. It is also disadvantageous for patients from distant areas. We investigated whether appropriate hospital selections are being carried out in Fukushima Prefecture. The subjects of the study were patients who were transported by doctor-helicopter since the services started. We investigated the medical conditions of patients at emergency scenes, whether they were transported to a hospital inside or outside the region, the means of transportation, and the final destination hospital. There were 450 flights, of which 295 were to emergency scenes, involving 307 patients. The majority were trauma patients (191 patients, 62.2%). The final destination hospital was the University Hospital for 104 patients (33.9%); 99 patients (30.3%) were transported to three emergency and critical care medical centers (ECCMCs) in other regions. Most patients were transported to appropriate hospitals in the respective regions. The means of transportation from the emergency scene was by doctor-helicopter in the largest number of cases (223 patients, 72.6%), and the final destination hospital was ECCMCs in 81.6% of cases. Patients from emergency scenes are transported by doctor-helicopter to appropriate hospitals in the region, and hospitals in each region are cooperating with the doctor-helicopter operations.

HELICOPTER EMERGENCY MEDICAL SERVICES (DOCTOR-HELICOPTER) IN FUKUSHIMA PREFECTURE: PRESENT STATE AND PROBLEMS

The purpose of this study is to identify the problems in operating an emergency medical service helicopter with an emergency medicine doctor on board (doctor-helicopter) in Fukushima Prefecture, Japan, which covers wide regions and many rural areas. The study looked at the numbers of flights and patients during the 523 days since the start of the doctor-helicopter service at the Fukushima Medical University Hospital. The items investigated were: number of flights, number of helicopter dispatches per month, number of patients, the hospitals where patients were taken to, the fire department dispatch centers that requested the doctor-helicopter, and the number of times each doctor flew on the helicopter. There were 450 flights. When the service was started, there were a few flights, but they gradually increased. The majority of the flights were to emergency scenes (295), while 75 flights were interfacility transports of critically ill patients, 79 flights were cancelled after take-off, and one flight was for a disaster relief operation. The nature of requests differed greatly depending on the fire department dispatch center requesting the service. The majority of patients were trauma patients (62.2%). Stroke (8.5%) and acute coronary syndrome (5.2%) patients requiring emergency treatment were fewer than anticipated. The final destination hospitals were appropriate hospitals in the region. Because the number of flight doctors is small, the burden on individual doctors is large. A system for early on-site diagnosis and helicopter request by emergency rescue team is required to maintain a high quality of emergency care.

For Emergency Medical Service Helicopter Pilots, All Wind Is Local

As an EMS (emergency medical service helicopter) Helicopter pilot you are often asked to stretch your skills to the limit when landing in a remote area to pick up an injured patient on a gusty windy night. With pressure to get the patient to the nearest hospital where medical doctors may save a life, it is easy to forget that the approach to the hospital landing pad may be the most challenging segment of your flight. It should be easy; you have a lighted landing pad, wind socks, wind instruments, regional ambient wind (Ambient wind is unobstructed by terrain, buildings, and vegetation such as that reported by nearby automated surface observing systems [ASOS] and automated weather observing systems [AWOS] airport weather station or properly sited on highest nearby facility.) reports, maybe even global positioning system (GPS) approaches, and you have made many safe landings at this hospital in the past. Unfortunately, all wind is local. Wind conditions can change dramatically over very short distances, with hospital buildings and nearby obstacles creating dangerous wind shifts, downdrafts, and turbulence that can lead to emergency helicopter incidents in this final segment of flight.

Helicopter Evacuation of Trauma Victims in Los Angeles: Does it Improve Survival?

The purpose of this study was to investigate the relationship between the method of transport after injury and survival among trauma patients admitted to a Level 1 trauma facility in Los Angeles, California. The trauma registry of LAC+USC Medical Center was reviewed to identify all injured patients evacuated by emergency medical service (EMS) from the injury scene from 1998 to 2007. The study population was divided into those who were airlifted (HEMS) and those who were transported by ground emergency medical service (GEMS) with transportation time that exceeded 30 minutes (GEMS > 30 minutes). During the 10-year study period, 1,836 patients were airlifted (helicopters for emergency medical service (HEMS)) and 1,537 patients were ground transported (GEMS > 30 minutes). HEMS patients suffered more frequently a penetrating injury (19% vs. 11%, p < 0.001), presented more often hypotensive to the emergency department (4% vs. 1%, p < 0.001), had more frequently a Glasgow Coma Scale (GCS) < or = 8 (9% vs. 3%, p < 0.001) and required more often an intubation at the injury scene (1.6% vs. 0.4%, p < 0.001). However, the transportation time and the total prehospital time were significantly shorter for airlifted patients. After multivariable analysis, the difference in mortality between the two transport modalities was not significant (adjusted odds ratio (95% confidence interval, 0.72 (0.22, 2.35); p = 0.596). In a metropolitan Los Angeles trauma system, EMS helicopter transportation of injured patients does not appear to improve overall adjusted survival after injury. There is however a potential benefit for severely injured subgroups of patients due to the shorter prehospital times.

A 6-Year Analysis of German Emergency Medical Services Helicopter Crashes

Annually, there are about 80,000 helicopter emergency medical services (HEMS) missions for patients in Germany. In comparison to the commercial transport of passengers, the risk of aviation crashes increases during rescue operations. The aim of this study was to evaluate helicopter crashes related to HEMS in Germany within a 6-year period (1999-2004) and to analyze contributing factors. Flight crashes were identified in the annually published flight crash reports of the Federal Agency for Flight Accident Investigation. Data were completed by telephone interview of the operators and by additional internet information. For statistical analysis, Fisher's exact test was used. A p < 0.05 was considered significant. Twenty-four helicopter crashes (n = 22 during day, n = 2 at night) of German HEMS were identified within the 6 years. Three crashes were fatal, another two caused nonfatal injuries. Seven persons were killed, four injured severely and four slightly. Patients were not hurt within the analyzed period. The crash rate per 10,000 missions sank significantly (p < 0.05), whereas no reduction was found per 100,000 flight hours (not significant) compared with previously published data. Fifty-four percent (n = 13) of all crashes were reported during approach and landing. Seventeen percent (n = 4) of the crashes occurred during ground run and 29% (n = 7) during the remaining flight phases (takeoff and cruise flight). In comparison to previous data a significantly lower crash rate per 10,000 missions was found. With the analysis of the same data per 100,000 flying hours, this trend was not evident. The majority of crashes occurred during the day and landings.

Helicopter Emergency Medical Services (HEMS): Impact on On-Scene Times

This study compared prehospital on-scene times (OSTs) for patients treated by nurse-staffed emergency medical services (EMS) with OST for patients treated by a combination of EMS and physician-staffed helicopter emergency medical services (HEMS). A secondary aim was to investigate the relationship between length of OST and mortality. All trauma patients treated in the priority 1 emergency room of a Level I trauma center between January 2002 and 2004 were included in the study. To determine OST and outcome, hospital and prehospital data were entered into the trauma registry. OSTs for EMS and combined EMS/HEMS-treated patients were compared using linear regression analysis. Logistic regression analysis was used to compare mortality rates. The number of trauma patients included for analysis was 1,457. Of these, 1,197 received EMS assistance only, whereas 260 patients received additional care by an HEMS physician. HEMS patients had longer mean OSTs (35.4 vs. 24.6 minutes; p < 0.001) and higher Injury Severity Scores (24 vs. 9; p < 0.001). After correction for patient and trauma characteristics, like the Revised Trauma Score, age, Injury Severity Scores, daytime/night-time, and mechanism of trauma, the difference in OSTs between the groups was 9 minutes (p < 0.001). Logistic regression analyses showed a higher uncorrected chance of dying with increasing OST by 10 minutes (OR, 1.2; p < 0.001). This apparent effect of OST on mortality was explained by patient and trauma characteristics (adjusted OR, 1.0; p = 0.89). Combined EMS/HEMS assistance at an injury scene is associated with longer OST. When corrected for severity of injury and patient characteristics, no influence of longer OST on mortality could be demonstrated.

EMS Helicopter Crashes: What Influences Fatal Outcome?

In recent years, air transport of patients has been associated with disproportionate increases in crashes and deaths. We identify factors related to fatal outcome in air medical helicopter crashes and suggest preventive measures. This was a retrospective study using National Transportation Safety Board records for helicopter emergency medical services (EMS) crashes between January 1, 1983, and April 30, 2005. The main outcome measure was the percentage of air medical crashes resulting in 1 or more deaths. There were 182 helicopter EMS crashes during the 22.3-year study period; 39% were fatal. One hundred eighty-four occupants died: 45% of the 44 patients and 32% of the 513 crewmembers. Fifty-six percent of crashes in darkness were fatal compared with 24% of crashes not in darkness. Seventy-seven percent of crashes in instrument meteorological conditions were fatal compared with 31% in visual conditions. Thirty-nine percent of all deaths occurred in crashes with postcrash fires; 76% of crashes with postcrash fire were fatal compared with 29% of other crashes. Multivariate logistic regression revealed that controlling for other factors, the odds of fatal outcome was increased by postcrash fire (odds ratio [OR] 16.1; 95% confidence interval [CI] 5.0 to 51.5], bad weather (OR 8.0; 95% CI 2.4 to 26.0), and darkness (OR 3.2; 95% CI 1.3 to 7.9). Fatalities after helicopter EMS crashes are associated especially with postcrash fire and with crashes that occur in darkness or bad weather and can be addressed with improved crashworthiness and measures to reduce flights in hazardous conditions. Further studies will be necessary to determine which changes will decrease the fatal crash rate and which are cost effective.

Emergency medical service helicopter: On-scene missions without landing

Emergency medical service helicopter: On-scene missions without landing

72P The Pennsylvania emergency medical service helicopter registry

72P The Pennsylvania emergency medical service helicopter registry

Factors associated with the safety of EMS helicopters

The accident rate for emergency medical service (EMS) helicopters is thought to be approximately twice the rate for other commercial (Part 135) helicopters. This observation has led to numerous news reports and to the publication of conclusions of a National Transportation Safety Board investigation. The data for these reports come from investigations of EMS helicopter accidents and incidents. The authors surveyed all listed civilian EMS helicopter programs to examine both helicopter ambulance mishaps and the number of safely completed missions. Epidemiological methods were then used to compare the safety records of different groups of EMS helicopters. The single most important factor identified was the number of flights made by the program during the study period: busy programs had an eightfold lower accident rate ( P < .0005) and a three-fold lower total mishap (accidents + incidents) rate ( P < .0005) than less active programs. Programs with the ability to fly under instrument flight rules (IFR) at the pilots discretion had no mishaps ( P = .044) during the study period. Multivariate analysis shows this IFR capability to be marginally significant as an independent factor ( P = .099).

Pre-Flight Risk Assessment in Emergency Medical Service (EMS) Helicopters

The EMS industry has been the subject of several television and newspaper articles (Harvey and Jensen, 1987) which emphasized the negative aspects, (e.g., fatal accidents and high accident rates), rather than the life saving services performed. The accident rate of the EMS industry is five times as high as that of other civil helicopters. This high accident rate coupled with the dramatic rise in the number of programs (from a single service at its inception in 1972 to over 180 today, Spray, 1987), prompted the National Transportation Safety Board (NTSB) to study the accidents that occurred between May 11, 1978 and December 3, 1986 (NTSB, 1988). The NTSB report concluded that “Sound pilot judgment is central to safe flight operations.” They further stated that “… factors unique to EMS helicopter operations—such as the influence of the mission itself, program competition, and EMS program management perspectives—can drastically influence pilot judgment during the EMS mission.” One of the most difficult decisions that a pilot must make is whether to accept or decline a mission. A pre-flight risk assessment system (SAFE) was developed at NASA-Ames Research Center for civil EMS operations to aid pilots in making this decision objectively. The ability of the SAFE system to predict risk profiles of missions was tested at an EMS operator. The results of this field study demonstrated the the usefulness of SAFE was highly dependent on the type of mission flown.

The decision to add a second hospital-based EMS helicopter

An analysis of the first seven years of performance of our hospital-based emergency medical services (EMS) helicopter was conducted to evaluate the possible need for a second aircraft. A survey of seven hospitals currently operating two or more helicopters resulted in a consensus that one helicopter can effectively perform only 70 to 90 flights per month.The number of requests for our helicopter service has increased 148% from 610 to 1,512 in seven years while the number of completed missions has increased only 92% from 486 (40.5/month) to 935 (78/month).Requests denied due to inclement weather (265 in 1988) cannot be captured with a second visual-flight-rated (VFR) EMS helicopter; however, those missed due to maintenance requirements of the helicopter and overlapping requests (232 in 1988) can be captured.The need for a second aircraft exists when the number of requests for the service grows while the number of captured flights plateaus. Our data and industry survey suggests this will occur at 75 captured flights per month. Affordability and continued overall growth of trauma and other critical care referrals to the base hospital (s) is mandatory.This study provides a model for hospital-based EMS helicopter operators to apply to the decision whether to add a second aircraft.