Helicopter Emergency Medical Service Crew Research Articles

Effect of case identification changes on pre-hospital intubation performance indicators in an Australian helicopter emergency medical service.

A 45-min interval from injury to intubation has been proposed as a performance indicator for severe trauma patient management. In the Sydney pre-hospital system a previous change in case identification systems was associated with activation delay. We aimed to determine if this also decreased the proportion of patients intubated within this benchmark. Retrospective cohort study of patients intubated by a helicopter emergency medical service (HEMS) over two time periods. Period 1 dispatch was via HEMS crew directly screening the computerised dispatch system, and period 2 was via paramedics in a central control room. Times from emergency call to intubation were compared. In the HEMS crew screening period 46/58 (79.31%) intubations met the target, compared with 137/314 (43.6%) in the central control period (P < 0.001). The median (interquartile range) time to intubation in the direct crew screening period was 33 (25-41) min, versus the central control period at 47 (38-60) min (P < 0.001). On multivariate modelling, distance to the scene was related to time to intubation (P < 0.001; Incident Rate Ratio = 1.018, 95% confidence interval 1.015-1.020) as was dispatch system, entrapment/access difficulty and indication for intubation (all P < 0.001). Time from emergency call to intubation was significantly shorter in the HEMS screening period where all non-trapped cases less than 50 km distant were intubated within the 45-min benchmark. There was no distance where intubation within 45 min could be assured for non-trapped patients in the central control period due to dispatch delays.

A hybrid strategy using an ambulance and a helicopter to convey thrombectomy candidates to definite care: a prospective observational study

BackgroundMechanical thrombectomy is the treatment of choice for large vessel occlusion strokes done only in comprehensive stroke centres (CSC). We investigated whether the transportation time of thrombectomy candidates from another hospital district could be reduced by using an ambulance and a helicopter and how this affected their recovery.MethodsWe prospectively gathered the time points of thrombectomy candidates referred to the Tampere University Hospital from the hospital district of Southern Ostrobothnia. Primary and secondary transports were included. In Hybrid transport, the helicopter emergency medical services (HEMS) unit flew from an airport near the CSC to meet the patient during transport and continued the transport to definitive care. Ground transport was chosen only when the weather prevented flying, or the HEMS crew was occupied in another emergency. We contacted the patients treated with mechanical thrombectomy 90 days after the intervention and rated their recovery with the modified Rankin Scale (mRS). Favourable recovery was considered mRS 0–2.ResultsDuring the study, 72 patients were referred to the CSC, 71% of which were first diagnosed at the PSC. Hybrid transport (n = 34) decreased the median time from the start of transport from the PSC to the computed tomography (CT) at the CSC when compared to Ground (n = 17) transport (84 min, IQR 82–86 min vs. 109 min, IQR 104–116 min, p < 0.001). The transport times straight from the scene to CT at the CSC were equal: median 93 min (IQR 80–102 min) in the Hybrid group (n = 11) and 97 min (IQR 91–108 min) in the Ground group (n = 10, p = 0.28). The percentages of favourable recovery were 74% and 50% in the Hybrid and Ground transport groups (p = 0.38) from the PSC. Compared to Ground transportation from the scene, Hybrid transportation had less effect on the positive recovery percentages of 60% and 50% (p = 1.00), respectively.ConclusionAdding a HEMS unit to transporting a thrombectomy candidate from a PSC to CSC decreases the transport time compared to ambulance use only. This study showed minimal difference in the recovery after thrombectomy between Hybrid and Ground transports.

Fatigue risk assessment of a Helicopter Emergency Medical Service crew working a 24/7 shift pattern: results of a prospective service evaluation

BackgroundThe work of Helicopter Emergency Medical Services (HEMS) teams crosses the boundaries of several high-risk occupations including medicine, aviation, and transport. Working conditions can be challenging and operational demands requires a 24-h rota, resulting in disruption of the normal circadian rhythm. HEMS crews are therefore prone to both mental and physical fatigue. As fatigue in medical providers is linked to poor cognitive performance, degradation of psychomotor skills and error, this study aimed to explore the existence of predictable patterns of crew-fatigue in a HEMS service.MethodsHEMS medical crew members working a 3-on 3-off forward rotating rota with a 5-week shift cycle were asked to do psychomotor vigilance tests (PVT) as an objective measure of fatigue. PVT testing was undertaken at the start, mid- and at the end of every shift during a full 5-week shift cycle. In addition, they were asked to score subjective tiredness with the Samn-Perelli Fatigue Scale (SPFS), and to keep a Transport Fatigue Assessment shift log, wherein they noted shift characteristics potentially related to fatigue. Primary outcome of interest was defined as the change in PVT and SPFS scores over time.ResultsMean baseline resting PVT in milliseconds at the start of the study period was 427 [390–464]. There was an overall trend towards higher PVT-scores with shift progression mean [95% CI] PVT at the start of shifts 447 [433–460]; halfway through the shift 452 [440–463]; end of the shift 459 [444–475], p = 0.10), whereas SPFS scores remained constant. Within a 5 week forward-rotating cycle, an overall trend towards a gradual increase in both average PVT (from 436 [238–454] to 460 [371–527, p = 0.68] ms;) and SPFS (from 2.9 [2.6–3.2] to 3.6 [3.1–4.0], p = 0.38) was observed, although significant interindividual variation was present. Reported SPFS scores ≥ 4 (moderate fatigue) were mainly related to workload (number of jobs) and transport mode (car-based shifts).ConclusionAn overall trend towards a decline in psychomotor vigilance and an increase in self-reported tiredness was found for HEMS crew over a 5-week shift cycle. Using a bespoke predictive fatigue tool on a day-to-day basis could increase fatigue awareness and provide a framework to which relevant mitigating options can be applied.

Trigger tool-based description of adverse events in helicopter emergency medical services in Qatar

IntroductionAdverse events (AEs) in helicopter emergency medical services (HEMS) remain poorly reported, despite the potential for harm to occur. The trigger tool (TT) represents a novel approach to AE detection...

Feasibility of HEMS performed prehospital extracorporeal-cardiopulmonary resuscitation in paediatric cardiac arrests; two case reports

IntroductionA broad range of pathophysiologic conditions can lead to cardiopulmonary arrest in children. Some of these children suffer from refractory cardiac arrest, not responding to basic and advanced life support. Extracorporeal-Cardiopulmonary Resuscitation (E-CPR) might be a life-saving option for this group. Currently this therapy is only performed in-hospital, often necessitating long transport times, thereby negatively impacting eligibility and chances of survival. We present the first two cases of prehospital E-CPR in children performed by regular Helicopter Emergency Medical Services (HEMS).Case presentationsThe first patient was a previously healthy 7 year old boy who was feeling unwell for a couple of days due to influenza. His course deteriorated into a witnessed collapse. Direct bystander CPR and subsequent ambulance advanced life support was unsuccessful in establishing a perfusing rhythm. While doing chest compressions, the patient was seen moving both his arms and making spontaneous breathing efforts. Echocardiography however revealed a severe left ventricular impairment (near standstill). The second patient was a 15 year old girl, known with bronchial asthma and poor medication compliance. She suffered yet another asthmatic attack, so severe that she progressed into cardiac arrest in front of the attending ambulance and HEMS crews. Despite maximum bronchodilator therapy, intubation and the exclusion of tension pneumothoraxes and dynamic hyperinflation, no cardiac output was achieved.InterventionAfter consultation with the nearest paediatric E-CPR facilities, both patients were on-scene cannulated by regular HEMS. The femoral artery and vein were cannulated (15-17Fr and 21Fr respectively) under direct ultrasound guidance using an out-of-plane Seldinger approach. Extracorporeal Life Support flow of 2.1 and 3.8 l/min was established in 20 and 16 min respectively (including preparation and cannulation). Both patients were transported uneventfully to the nearest paediatric intensive care with spontaneous breathing efforts and reactive pupils during transport.ConclusionThis case-series shows that a properly trained regular HEMS crew of only two health care professionals (doctor and flight nurse) can establish E-CPR on-scene in (older) children. Ambulance transport with ongoing CPR is challenging, even more so in children since transportation times tend to be longer compared to adults and automatic chest compression devices are often unsuitable and/or unapproved for children. Prehospital cannulation of susceptible E-CPR candidates has the potential to reduce low-flow time and offer E-CPR therapy to a wider group of children suffering refractory cardiac arrest.

Impact of Point-of-Care Ultrasound on Prehospital Decision Making by HEMS Physicians in Critically Ill and Injured Patients: A Prospective Cohort Study.

Several studies have shown the additional benefit of point-of-care ultrasound (POCUS) by prehospital Emergency Medical Services (EMS). Since organization of EMS may vary significantly across countries, the value of POCUS likely depends on the prehospital system in which it is used. In order to be able to optimally implement POCUS and develop a tailored training curriculum, it is important to know how often POCUS is currently used, for which indications it is used, and how it affects decision making. The aims of this study were: (1) to determine the percentage of patients in whom POCUS was used by Dutch Helicopter Emergency Medical Services (HEMS) crews; (2) to determine how often POCUS findings led to changes in on-scene management; and (3) what these changes were. Patients who received prehospital care from December 1, 2020 through March 31, 2021 by a single HEMS crew were included in this prospective cohort study. Clinical data and specific data on POCUS examination, findings, and therapeutic consequences were collected and analyzed. During the study period, on-scene HEMS care was provided to 612 patients, of which 211 (34.5%) patients underwent POCUS. Of these, 209 (34.2%) patients with a median age of 45 years were included. There were 131 (62.7%) trauma patients, and 70 (33.7%) of the included patients underwent cardiopulmonary resuscitation (CPR). The median reported time of POCUS examination was three (P25-P75 2-5) minutes. Median prolongation of on-scene time was zero (P25-P75 0-1) minutes. In 85 (40.7%) patients, POCUS examination had therapeutic consequence: POCUS was found to impact treatment decisions in 34 (26.0%) trauma patients and 51 (65.4%) non-trauma patients. In patients with cardiac arrest, POCUS was most often used to aid decision making with regard to terminating or continuing resuscitation (28 patients; 13.4%). During the study period, POCUS examination was used in 34.5% of all prehospital HEMS patients and had a therapeutic consequence in 40.7% of patients. In trauma patients, POCUS seems to be most effective for patient triage and evaluation of treatment effectiveness. Moreover, POCUS can be of significant value in patients undergoing CPR. A tailored HEMS POCUS training curriculum should include ultrasound techniques for trauma and cardiac arrest.

Combining in-situ simulation and live HEMS mission facilitator observation: a flexible learning concept

BackgroundContinuous medical education is essential in Helicopter Emergency Medical Services (HEMS). In-situ simulation training makes it possible to train in a familiar environment. The use of a dedicated facilitator is essential; however, when an in-situ simulation training session is interrupted by a live mission, the efforts invested in the training are left unfulfilled. This study aims to evaluate if HEMS mission observation and debriefing by the simulation facilitator is a feasible alternative to mission-interrupted simulation training, and how this alternative to simulation training is perceived by both facilitators and HEMS crew members.MethodsFacilitator observation during live missions and post-mission debriefing was offered as an alternative to mission-interrupted simulation training over a one-year period at three HEMS bases. Immediate feedback was requested from crews and facilitators after each observed live mission on a predefined questionnaire. At the end of the study period, semi-structured interviews were performed with a sample of HEMS crew members and facilitators to further explore the experience with the concept. Numerical data about the sessions were recorded continuously.ResultsA total of 78 training sessions were attempted, with 46 (59%) of the simulations conducted as planned. Of the remaining, 23 (29%) were not started because the crew had other duties (fatigued crew or crew called for a mission where observation was inappropriate/impossible), and 9 (12%) training sessions were converted to observed live missions. In total, 43 (55%), 16 (21%) and 19 (24%) attempts to facilitate simulation training were undertaken on the three bases, respectively. The facilitators considered mission observation more challenging than simulation. The interviews identified local know-how, clinical skills, and excellent communication skills as important prerequisites for the facilitators to conduct live mission observation successfully. Participating crews and facilitators found simulation both valuable and needed. Being observed was initially perceived as unpleasant but later regarded as a helpful way of learning.ConclusionLive mission observation and debriefing seems a feasible and well-received alternative to an in-situ simulation program in HEMS to maximise invested resources and maintain the learning outcome. Furthermore, additional training of simulation facilitators to handle the context of live mission observation may further improve the learning output.

Rescue Operations Lead to Increased Cardiovascular Stress in HEMS Crew Members: A Prospective Pilot Study of a German HEMS Cohort

Helicopter emergency medical service (HEMS) is an essential part of prehospital emergency medicine. The working conditions lead to high physical stress, especially in rescue operations. The study aimed to determine the cardiovascular stress profile during rescue situations in HEMS crew members. Twenty-one HEMS crew members (male n = 20) participated in the prospective study. Heart rate, blood pressure and long-term ECG measurements were recorded during the whole operation day. The changes of measurements during rescue operation (52 operations in total) were compared to these of standby time. Rescue operations lead to increased load on the cardiovascular system, as expressed by significantly higher blood pressure, heart rate values and rate of cardiac events compared to standby time. Of special note, the difference in systolic blood pressure mean was 7.4 ± 9.0 mmHg (CI [5.1; 9.7], p < 0.001). Maximal heart rate was on average 33.7 bpm higher during rescue operation than in the standby time (CI [26.2; 40.8], p < 0.001). Cardiac events occurred significantly more frequently during the period of rescue operation than in standby time hours (p = 0.02). The results reported a significant load on the cardiovascular system during rescue operations in HEMS crew members. Therefore, it is necessary to carry out a risk stratification of the HEMS crew members to prevent cardiovascular risk and events.

Analysis of tracheal intubation in out-of-hospital helicopter emergency medicine recorded by video laryngoscopy

BackgroundTracheal intubation remains the gold standard of airway management in emergency medicine and maximizing safety, intubation success, and especially first-pass intubation success (FPS) in these situations is imperative.MethodsWe conducted a prospective observational study on all 12 helicopter emergency medical service (HEMS) bases of the Swiss Air Rescue, between February 15, 2018, and February 14, 2019. All 428 patients on whom out-of-hospital advanced airway management was performed by the HEMS crew were included. The C-MAC video laryngoscope was used as the primary device for tracheal intubation. Intubation procedures were recorded by the video laryngoscope and precise time points were recorded to verify the time necessary for each attempt and the overall procedure time until successful intubation. The videos were further analysed for problems and complications during airway management by an independent reviewer. Additionally, a questionnaire about the intubation procedure, basic characteristics of the patient, circumstances, environmental factors, and the provider’s level of experience in airway management was filled out. Main outcome measures were FPS of tracheal intubation, overall success rate, overall intubation time, problems and complications of video laryngoscopy.ResultsFPS rate was 87.6% and overall success rate 98.6%. Success rates, overall time to intubation, and subjective difficulty were not associated to the providers’ expertise in airway management. In patients undergoing CPR FPS was 84.8%, in trauma patients 86.4% and in non-trauma patients 93.3%. FPS in patients with difficult airway characteristics, facial trauma/burns or obesity ranges between 87 and 89%. Performing airway management indoors or inside an ambulance resulted in a significantly higher FPS of 91.1% compared to outdoor locations (p < 0.001). Direct solar irradiation on the screen, fogging of the lens, and blood on the camera significantly impaired FPS. Several issues for further improvements in the use of video laryngoscopy in the out-of-hospital setting and for quality control in airway management were identified.ConclusionAirway management using the C-MAC video laryngoscope with Macintosh blade in a group of operators with mixed experience showed high FPS and overall rates of intubation success. Video recording emergency intubations may improve education and quality control.

In situ simulation training in helicopter emergency medical services: feasible for on-call crews?

Simulation-based training of emergency teams offers a safe learning environment in which training in the management of the critically ill patient can be planned and practiced without harming the patient. We developed a concept for in situ simulation that can be carried out during on-call time. The aim of this study is to investigate the feasibility of introducing in situ, simulation-based training for the on-call team on a busy helicopter emergency medical service (HEMS) base.We carried out a one-year prospective study on simulation training during active duty at a busy Norwegian HEMS base, which has two helicopter crews on call 24/7. Training was conducted as low fidelity in situ simulation while the teams were on call. The training took place on or near the HEMS base. Eight scenarios were developed with learning objectives related to the mission profile of the base which includes primary missions for both medical and trauma patients of all ages, and interhospital transport of adults, children, and neonates. All scenarios included learning objectives for non-technical skills. A total of 44 simulations were carried out. Total median (quartiles) time consumption for on-call HEMS crew was 65 (59-73) min. Time for preparation of scenarios was 10 (5-11) min, time for simulations was 20 (19-26) min, cleaning up 7 (6-10) min, and debrief 35 (30-40) min. For all items on the questionnaire, the majority of respondents replied with the two most positive categories on the Likert scale. Our results demonstrate that in situ simulation training for on-call crews on a busy HEMS base is feasible with judicious investment of time and money. The participants were very positive about their experience and the impact of this type of training.

Characteristics of urban versus rural utilization of the Polish Helicopter Emergency Medical Service in patients with ST-segment elevation myocardial infarction.

In patients with acute phase of ST‑segment elevation myocardial infarction (STEMI), quick transportation to a specialist therapeutic center is of utmost importance to increase the chances of surviving. The objective of this study was to characterize the missions of the Polish Helicopter Emergency Medical Service (HEMS) to patients with STEMI in urban and rural areas and to assess the utilization of air ambulance support as part of an early stage of the therapeutic process. This retrospective analysis included 6099 patients with STEMI treated by the Polish HEMS crews from January 2011 to December 2018. The study group included mainly men (68.9%) and persons aged 60 to 79 years (53.9%). The mean (SD) age of the entire group was 64.8 (11.9) years. The level of consciousness measured by the Glasgow Coma Scale score ranged from 13 to 15 (84.8% of patients), the mean (SD) Revised Trauma Score was 11.4 (1.9) points, and the mean (SD) number of points on the National Advisory Committee for Aeronautics scale was 4 (1). In rural areas, the Polish HEMS crews were more frequently dispatched to medical emergencies (99.3% vs 59.6%). Sudden cardiac arrest occurred more often in those areas (6% vs 3.8%), which resulted in the death of the patient (2.4% vs 0.4%; P <0.05 for both). There were differences in utilization of the Polish HEMS in patients with STEMI in urban and rural areas. The results demonstrated a positive impact of the utilization of HEMS in the early stages of the therapeutic process of these patients.

Polish Helicopter Emergency Medical Service (HEMS) Response to Stroke: A Five-Year Retrospective Study

BackgroundA stroke is a serious life-threatening emergency that requires immediate intervention in an appropriate therapeutic center. The aim of this study was to analyze the time of medical procedures at the scene and changes in the state of stroke patients during transport by HEMS in Poland. The presented research is the first nationwide study covering such a large group of stroke patients, for whom aerial support was used in the therapeutic process.Material/MethodsA retrospective cross-sectional study of 48553 missions performed by Polish Medical Air Rescue (PMAR) during the 5-year study period resulted in 3906 stroke patients who, after medical rescue operations by HEMS crew, were transported by helicopters to hospitals.ResultsHelicopters in 3475 (88.97%) cases were utilized as a support for Ground Emergency Medical Service (GEMS). The maximum duration of HEMS operation from activation to patient transfer to the hospital did not exceed 108 min and the median was 60 min. Over 87% of patients with HEMS reported stroke symptoms and arrived at the medical center with the possibility of implementing thrombolytic therapy. The factor that affected the deterioration of patients’ condition was the drawing out of the extent of time spent by the crew at the scene.ConclusionsThe use of HEMS in Poland in the case of patients with stroke symptoms ensures fast and professional assistance at the site of the medical emergency as well as safe transport to specialized centers, shortening the time of proper treatment implementation.

Sleepiness among personnel in the Norwegian Air Ambulance Service

Purpose To examine the effects of shift work and extended working hours on sleepiness among pilots and Helicopter Emergency Medical Service (HEMS) crew members in the Norwegian Air Ambulance.MethodsThis field study investigated sleepiness during 3 consecutive weeks: the week before work, the work week, and the week after work. The pilots and HEMS crew members (N = 50) kept a wake diary during all 3 weeks and completed reaction time tests during the work week.ResultsThe overall sleepiness scores were low during all 3 weeks. When comparing the 3 weeks, the lowest sleepiness levels were found for the work week. There was a small difference across work days, in which subjective sleepiness scores were highest the first duty day. No change in the reaction time tests was evident during the work week. The crew members reported being most sleepy at midnight, compared to all the other timepoints over the course of a duty day. Regarding workload and total work time, having larger workload was associated with lower sleepiness scores, while having higher total work time was associated with higher sleepiness score, both compared to the medium category.ConclusionsThe findings indicate that the work schedules and setting for this distinct occupational group do not seem to negatively affect the sleepiness levels.

Helicopter Emergency Medical Service (HEMS) Response in Rural Areas in Poland: Retrospective Study.

The aim of the study was to identify the characteristics of missions performed by HEMS (Helicopter Emergency Medical Service) crews and the analysis of health problems, which are the most common cause of intervention in rural areas in Poland. The study was conducted using a retrospective analysis based on the medical records of patients provided by the HEMS crew, who were present for the emergencies in rural areas in the period from January 2011 to December 2018. The final analysis included 37,085 cases of intervention by HEMS crews, which accounted for 54.91% of all the missions carried out in the study period. The majority (67.4%) of patients rescued were male, and just under a quarter of those rescued were aged between 50–64 years. Injuries (51.04%) and cardiovascular diseases (36.49%) were the main diagnoses found in the study group. Whereas injuries were significantly higher in the male group and patients below 64 years of age, cardiovascular diseases were higher in women and elderly patients (p < 0.001). Moreover, in the group of women myocardial infarction was significantly more frequent (30.95%) than men, while in the group of men head injuries (27.10%), multiple and multi-organ injuries (25.93%), sudden cardiac arrest (14.52%), stroke (12.19%), and epilepsy (4.95%) was significantly higher. Factors that are associated with the most common health problems of rural patients are: gender and age, as well as the seasons of the year and the values of the Glasgow Coma Scale (GCS), Revised Trauma Score (RTS), and National Advisory Committee for Aeronautics (NACA) used to assess the clinical status of patients.

BURNS IN PRACTICE OF HELICOPTER EMERGENCY MEDICAL SERVICE IN POLAND. RETROSPECTIVE ANALYSIS

Introduction: Burns are a huge problem for public health and a challenge for healthcare systems all around the world. They are responsible for 180.000 deaths worldwide each year. In order to ensure high quality treatment and rehabilitation of these patients burn centres are established in many countries. Another vital factor influencing the prognosis of patients with burns is quick transport that in many countries, including Poland is carried out by Helicopter Emergency Medical Service (HEMS). The aim: To describe the operations carried out by HEMS with particular stress put on the target medical facility. Materials and methods: The research was conducted with the method of retrospective analysis of operations performed by HEMS crews. All missions from January 2011 to December 2018 were included in the study and 2534 cases were qualified for the final analysis. Results: The study group was predominantly male (72.72%) aged 18 years old and less (36.65%). Nearly two thirds of the patients were transported to hospitals with a burn ward (61.88%). Opioid analgesics as well as crystalloids were the most commonly administered drugs (respectively 68.55% and 64.76%). Statistical analysis showed that HEMS arrival time (20.77 minutes vs 18.60 minutes) and duration of the transport to designated hospital (40.11 minutes vs 19.66 minutes) were significantly higher in the cases of deciding to transport the patient to the hospital with the burns department (p<0.001). Conclusions: Presented results showed that HEMS crews are more often assigned to help ground-based Medical Rescue Teams in case of patients who required treatment in burn centres. Moreover, the time and distance to the hospital with burn ward was significantly longer compared to other healthcare facilities. This confirms that the assigning of HEMS crews for the patients with severe burns was reasonable.

Helicopter Emergency Medical Services in Buenos Aires: An Operational Overview

As part of the emergency medical care system, helicopter emergency medical services (HEMS) have a different crew composition from the traditional team. HEMS consist of a pilot, doctor, and firefighter with rescue skills and training in basic life support on board an air ambulance. This allows the adaptation to different environments and increases the varieties of air procedures normally performed. HEMS began operating relatively recently in Buenos Aires. Yet, in 3 years, its use grew to such an extent that in 2015 it tripled, and by 2016 the number of medical assists was 4 times greater than in 2014. Furthermore, over the 3-year study period, 92% to 95% of assisted victims were traffic accident casualties requiring primary care. The HEMS crew is informed about the availability of resources in the acute care general hospitals and can therefore transfer patients to the most appropriate trauma center in the shortest time. However, 75% to 85% of the time, the choice of destination is strongly influenced by the availability of a helipad and the operational safety that it provides.

A comparative study on the frequency of simulation-based training and assessment of non-technical skills in the Norwegian ground ambulance services and helicopter emergency medical services

BackgroundInadequate non-technical skills (NTSs) among employees in the Norwegian prehospital emergency medical services (EMSs) are a risk for patient and operational safety. Simulation-based training and assessment is promising with respect to improving NTSs. The frequency of simulation-based training in and assessment of NTSs among crewmembers in the Norwegian helicopter emergency medical service (HEMS) has gained increased attention over recent years, whereas there has been much less focus on the Norwegian ground emergency medical service (GEMS). The aim of the study was to compare and document the frequencies of simulation-based training in and assessment of seven NTSs between the Norwegian HEMS and GEMS, conditional on workplace and occupation.MethodA comparative study of the results from cross-sectional questionnaires responded to by employees in the Norwegian prehospital EMSs in 2016 regarding training in and assessment of NTSs during 2015, with a focus on the Norwegian GEMS and HEMS. Professional groups of interest are: pilots, HEMS crew members (HCMs), physicians, paramedics, emergency medical technicians (EMTs), EMT apprentices, nurses and nurses with an EMT licence.ResultsThe frequency of simulation-based training in and assessment of seven generic NTSs was statistically significantly greater for HEMS than for GEMS during 2015. Compared with pilots and HCMs, other health care providers in GEMS and HEMS undergo statistically significantly less frequent simulation-based training in and assessment of NTSs. Physicians working in the HEMS appear to be undergoing training and assessment more frequently than the rest of the health trust employees. The study indicates a tendency for lesser focus on the assessment of NTSs compared to simulation-based training.ConclusionHEMS has become superior to GEMS, in terms of frequency of training in and assessment of NTSs. The low frequency of training in and assessment of NTSs in GEMS suggests that there is a great potential to learn from HEMS and to strengthen the focus on NTSs. Increased frequency of assessment of NTSs in both HEMS and GEMS is called for.

Noise exposure during prehospital emergency physicians work on Mobile Emergency Care Units and Helicopter Emergency Medical Services

BackgroundPrehospital personnel are at risk of occupational hearing loss due to high noise exposure. The aim of the study was to establish an overview of noise exposure during emergency responses in Mobile Emergency Care Units (MECU), ambulances and Helicopter Emergency Medical Services (HEMS). A second objective was to identify any occupational hearing loss amongst prehospital personnel.MethodsNoise exposure during work in the MECU and HEMS was measured using miniature microphones worn laterally to the auditory canals or within the earmuffs of the helmet. All recorded sounds were analysed in proportion to a known tone of 94 dB. Before and after episodes of noise exposure, the physicians underwent a hearing test indicating whether the noise had had any impact on the function of the outer sensory hair cells. This was accomplished by measuring the amplitude level shifts of the Distortion Product Otoacoustic Emissions. Furthermore, the prehospital personnels’ hearing was investigated using pure-tone audiometry to reveal any occupational hearing loss. All prehospital personnel were compared to ten in-hospital controls.ResultsOur results indicate high-noise exposure levels of ≥80 dB(A) during use of sirens on the MECU and during HEMS operations compared to in-hospital controls (70 dB(A)). We measured an exposure up to ≥90 dB(A) under the helmet for HEMS crew. No occupational hearing loss was identified with audiometry. A significant level shift of the Distortion Product Otoacoustic Emissions at 4 kHz for HEMS crew compared to MECU physicians was found indicating that noise affected the outer hair cell function of the inner ear, thus potentially reducing the hearing ability of the HEMS crew.DiscussionFurther initiatives to prevent noise exposure should be taken, such as active noise reduction or custom-made in-ear protection with communication system for HEMS personnel. Furthermore, better insulation of MECU and ambulances is warranted.ConclusionWe found that the exposure levels exceeded the recommendations described in the European Regulative for Noise, which requires further protective initiatives. Although no hearing loss was demonstrated in the personnel of the ground-based units, a reduced function of the outer sensory hair cells was found in the HEMS group following missions.

Evaluation of overweight and obesity in Helicopter Emergency Medical Service (HEMS) worker

Obesity now affects people from all walks of life, including those who work in the field of medical aid provision on a daily basis. So far, there has been no research assessing the nutrition status of Helicopter Emergency Medical Service (HEMS) crews. To evaluate the degree to which overweight and obesity prevail among Helicopter Emergency Medical Service Air Ambulances (HEMS LPR) crew members, and determine the overall excess body fat and fatty tissue distribution in the subjects. In order to evaluate the prevalence of overweight and obesity in HEMS crew members, the following anthropometric measurements were used: height, body mass, waist and hip circumferences. Assessment of their nutritional status was made by using some generally used indicators, i.e. calculating the subjects' BMI, WHR and WHtR. Pilots were older than the paramedics in a statistically significant way. On the basis of using the BMI indicator, it was shown that only 36% of HEMS crew members had normal body weight. Analysis of the percentage of body fat determined that 61.5% of the paramedics and 39.4% of the pilots had normal weight. 26.2% paramedics and 28.8% pilots were diagnosed as overweight. Obesity characterised 12.3% of paramedics and 31.8% of pilots. The above were statistically significant differences (p= 0.0117). Waist circumference exceeded 102 cm in 25.9% of the subjects and WHR>1 characterised 20.6% of those examined. Analysis of the results obtained revealed that an alarmingly high percentage of crew members suffer from excessive body mass and fat, particularly in the group of pilots. Immediate action should be taken in order to reduce the body mass and introduce preventive measures among the subjects.

An online learning programme improves traumatic brain injury guideline adherence in a South African Helicopter Emergency Medical Service

It is difficult to initiate clinical quality improvement projects through continuous education in the prehospital environment due to the very nature of their mobile workplace and unpredictable presence in a specific location. This study reviews the impact of an online learning platform and the effect it had on the clinical quality of care offered to patients with traumatic brain injury (TBI) during Helicopter Emergency Medical Services (HEMS) operations. A prospective improvement project was initiated to improve the clinical care for patients with TBI. A clinical monitoring tool, based on the prehospital care guidelines of the Brain Trauma Foundation was designed to assess the clinical quality of TBI patient care. The clinical indicators measured included initial Glasgow Coma Score, motor function, pupil size and reactivity, hypotension, hypoxaemia, carbon dioxide levels, temperature control, and patient position. A four month baseline monitoring was completed to determine the level of adherence to the guidelines, and subsequently an online, free access lecture series was presented to the HEMS operational staff. The clinical monitoring tool was applied during this time and afterwards to review adherence to guidelines. A total of 71 cases of TBI were seen during the period of assessment and 64.8% of HEMS crew participated in the online training programme. A change in the average adherence to the clinical guidelines improved from 66.9% to 75.7% (p = 0.033) from the baseline monitoring period, to the period immediately after the online training. Free and open online learning platforms can be implemented at little to no cost and can be accessed anywhere. This initiative has shown benefit in ensuring best care for critically ill TBI HEMS patients. Il est difficile d’initier des projets d’amélioration de la qualité clinique au sein des SMUH par le biais d’une formation continue dans l’environnement pré-hospitalier en raison de la nature même du lieu de travail mobile de ses membres, et de leur présence imprévisible en un lieu ou un autre. Cette étude examine l’impact d’une plateforme d’apprentissage en ligne et son effet sur la qualité clinique de la prise en charge proposée aux patients victimes de lésions cérébrales traumatiques (LCT) au cours des opérations des Services médicaux d’urgence par hélicoptère (SMUH). Un projet d’amélioration prospectif a été entamé afin d’améliorer la prise en charge clinique des patients victimes de LCT. Un outil de suivi clinique, fondé sur les directives de prise en charge pré-hospitalière de la Brain Trauma Foundation, a été développé afin d’évaluer la qualité clinique de la prise en charge des patients victimes de LCT. Les indicateurs cliniques mesurés incluaient l’échelle de coma de Glasgow, les fonctions motrices, la dimension de la pupille et sa réactivité, l’hypotension, l’hypoxémie, le taux de dioxyde de carbone, le contrôle de la température et la position du patient. Un suivi de référence sur quatre mois a été réalisé afin de déterminer le degré de respect des directives et par la suite, une série de cours en accès libre a été présentée au personnel opérationnel du SMUH. L’outil de suivi clinique a été appliqué au cours de cette période et par la suite, afin d’examiner le respect des directives. Au total, 71 cas de LCT ont été vus au cours de la période d’évaluation, et 64,8% des membres de l’équipe du SMUH ont participé au programme de formation en ligne. Un changement a été observé dans le respect moyen des directives cliniques, qui s’est amélioré pour passer de 66,9% à 75,7% (p = 0,033) entre la période de suivi de référence et la période suivant immédiatement la formation en ligne. Les plateformes d’apprentissage en ligne gratuites et en accès libre peuvent être mises en œuvre à peu de frais, voire sans frais, et sont accessibles de n’importe où. Cette initiative a montré qu’elle était utile pour garantir la meilleure prise en charge possible pour les patients des SMUH victimes de graves LCT.