Helicopter Emergency Medical Services Operations Research Articles

Constrained path planning for manned–unmanned rotorcraft teaming in emergency medical service missions

This paper investigates the path-planning problem applied to an innovative Unmanned Air Vehicle teaming with a helicopter to increase safety during Helicopter Emergency Medical Services operations. The unmanned vehicle, a drone that optionally can be launched from the helicopter, has the mission to explore the area of operation to determine the meteorological and environmental conditions and to detect physical obstacles. It is initially found that the combination of probabilistically optimal Rapidly-exploring Random Tree (RRT∗\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$^{*}$$\\end{document}) as the global planner and of Bidirectional Rapidly-exploring Random Tree (BiRRT) as the local planner provides a nearly optimal global path and a rapid replanning in case new obstacles are detected. Adopting a Savitzky–Golay filter in an optional post-processing phase enables trajectory smoothing, thus improving its practicability. The feasibility of the identified trajectory for a rigid-body helicopter model is assessed by computing a first estimate of attitude, forces, control inputs, and rotor power from the trajectory points and curvature. This assessment shows that the RRT∗\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$^{*}$$\\end{document} used as a local planner provides replanned trajectories more feasible than BiRRT with comparable computational times.

What Do You Need? Information Requirements and Task Analysis of (Future) Advanced Air Mobility Pilots in the Emergency Medical Service

In the domain of Advanced Air Mobility (AAM), Simplified Vehicle Operations (SVOs) promise a reduction in handling complexity and training time for pilots. Designing a usable human–machine interface (HMI) for pilots of SVO-enabled aircraft requires a deep understanding of task and user requirements. This paper describes the results of two user research methods to gather these requirements. First, a traditional Helicopter Emergency Medical Service (HEMS) mission was examined using a Hierarchical Task Analysis (HTA). The findings were used to formulate a theoretical HTA for a single-piloted electric Vertical Take-Off and Landing (eVTOL) system in such a scenario. In the second step, qualitative interviews with seven subject matter experts (pilots and paramedic support) in HEMS operations produced vital user requirements for HMI development. Key findings emphasize the necessity of a simplified information presentation and collision avoidance support in the HMI.

Prehospital coagulation measurement by a portable blood analyzer in a helicopter emergency medical service (HEMS).

In helicopter emergency medical services, HEMS, coagulopathy presents both in trauma (e.g. consumption of coagulation factors) and non-trauma cases (e.g. anticoagulant use). Therefore, in HEMS coagulation measurements appear promising and Prothrombin Time (PT) and derived INR are attractive variables herein. We tested the feasibility of prehospital PT/INR coagulation measurements in HEMS. This study was performed at the Dutch HEMS, using a portable blood analyzer (i-Stat®1, Abbott). PT/INR measurements were performed on (hemodiluted) author's blood, and both trauma- and non-trauma HEMS patients. Device-related benefits of the i-Stat PT/INR system were portability, speed and ease of handling. Limitations included a rather narrow operational temperature range (16-30 °C). PT/INR measurements (n = 15) were performed on hemodiluted blood, and both trauma and non-trauma patients. The PT/INR results confirmed effects of hemodilution and anticoagulation, however, most measurement results were in the normal INR-range (0.9-1.2). We conclude that prehospital PT/INR measurements, although with limitations, are feasible in HEMS operations.

Preflight Risk Assessment for Improved Safety in Helicopter Emergency Medical Service Operations.

INTRODUCTION: Adverse weather and poor visual cues are common elements in night-time Helicopter Emergency Medical Service (HEMS) operations contributing to spatial disorientation and fatal accidents. Pilots are required to make weather-related preflight risk assessments to accept or reject a flight. This study's aim was to develop predictive risk assessment tools based on historical accident data to assist the decision-making process.METHODS: We analyzed 32 single-pilot HEMS night-time visual flight rules fatal accidents to identify contributory risk factors. Logistic regression analysis was used to develop prediction nomograms for nonvisual meteorological conditions (non-VMC), cause and nonsurvivable accidents as dependent variables. Risk factors such as temperature dew point spread, elevation difference, and years of HEMS pilot experience, were entered as continuous variables. Flight crew composition, pilot DTE (domain task experience) and flight rule capability, primary missions, and temperature dew point spread were entered as categorical variables. A point scoring matrix transposed model probability to likelihood and consequence severity.RESULTS: The nomograms correctly predicted the likelihood of entering non-VMC, accident cause, and sustaining a nonsurvivable accident in 75%, 55%, and 94% of cases, respectively. Using data from a recent nonsurvivable HEMS accident, the nomogram estimated a 92% probability (Very Likely) of nonsurvivable accident if visual cues were lost.CONCLUSION: These nomograms can provide preflight information to predict the likelihood of adverse safety outcomes occurring during a planned HEMS mission. While further development work is needed, this approach has the potential to improve HEMS operational safety.Aherne BB, Zhang C, Chen WS, Newman DG. Preflight risk assessment for improved safety in Helicopter Emergency Medical Service operations. Aerosp Med Hum Perform. 2019; 90(9):792-799.

Systems Safety Risk Analysis of Fatal Night Helicopter Emergency Medical Service Accidents.

INTRODUCTION: In the United States, the proportion of Helicopter Emergency Medical Service (HEMS) fatal accidents remained unchanged despite an overall decreasing accident rate. Previous research showed night HEMS operations influenced fatal outcomes. Pilots with <6 yr of HEMS domain task experience (low-DTE) had a higher likelihood of a night operational accident in conditions associated with adverse weather. This study sought to determine whether a difference existed between day and night fatal accident rates and identify influences contributing to night fatal HEMS accidents. Any risk factors identified will be used for a risk analysis to inform future operational safety of the night visual flight rule (VFR) HEMS transport system.METHODS: Historical accident data and industry hours were obtained. Both pilot DTE groups (low and high) and mission VFR and instrument flight rule (IFR) capability were identified using data from 32 night VFR operational fatal HEMS accidents. Accidents were stratified by loss of control and controlled flight into terrain, pilot DTE, and flight rule capability. The effectiveness of both DTE groups and both flight rule capabilities were measured using system safety risk analysis techniques.RESULTS: Night fatal accident rates were statistically different from daytime. Low-DTE pilots and the VFR capability combination had the highest likelihood of night operational nonsurvivable accident.CONCLUSION: Low-DTE pilots and the VFR capability were the least effective mission combination to avoid hazardous conditions at night and maintain spatial orientation, respectively. The analysis identified measures to reduce likelihood of night fatal operational accidents.Aherne BB, Zhang C, Chen WS, Newman DG. Systems safety risk analysis of fatal night Helicopter Emergency Medical Service accidents. Aerosp Med Hum Perform. 2019; 90(4):396-404.

ANALYSIS OF THE HEMS «NATIONAL SERVICE OF MEDICAL AVIATION» MISSIONS IN LENINGRAD REGION IN 2017

The aim of this study was to investigate the efficiency of National Service of Medical Aviation (St. Petersburg, Russia). This is anesthesiologist-staffed helicopter emergency medical service (HEMS) mostly intended for the from-the-field and interhospital transport of patients with severe trauma and life-threatening diseases from rural hospitals to specialized medical centers in St. Petersburg. In total, 219 patients were included, that were transported by HEMS in 2017. 44,3% of patients had major or multiple injuries, 21,0% suffered from acute heart diseases, 15,5% had strokes or brain trauma. No one patient’s death during the flight was observed. This study findings provided valuable information that may have an impact on the current staffing and accreditation criteria for HEMS operations in Russia.

A socio-economic analysis of increased staffing in the Norwegian helicopter emergency medical service

BackgroundThe European Aviation Safety Agency (EASA) is preparing a new set of regulations that will cover working and resting periods for crew members engaged in emergency medical services with helicopters (HEMS) and aeroplanes (AEMS). Such a shared European regulatory framework has already been introduced for the majority of commercial operations with aeroplanes, whereas national regulations are still in place for helicopter operations. A possible consequence of changing the regulations on working and resting periods for helicopter operations is that current abilities to provide 24-h, continuous emergency readiness with the same helicopter crew will be changed to a daily shift pattern with two, and even up to three, different crews to cover one 24-h period.MethodsA cost-benefit study is used to analyse whether changed working and resting periods, through the introduction of a shared European framework are socio-economically profitable for Norwegian helicopter emergency medical service (HEMS). For the study, relevant data is available for the total of nine HEMS helicopters of the three regions in Norway, for the period 2006–2013.The aim of the study is to document whether changed working and resting periods will be socio-economically beneficial for the Norwegian HEMS.ResultsThe expected present value of changing the current regulations on working and resting periods is estimated at negative 181 million NOK over a 40-year period. This includes the assumption that all missions that are not completed today due to limitation in crew availability will be completed upon introducing new working and resting periods. In the current regulatory regime for the Norwegian HEMS, there are on average seven missions per HEMS base annually that are not completed due to the limitations in crew availability with the current working and resting periods. Changing the regulations on working and resting periods is estimated to be cost-effective when a minimum of 14 missions per year are prevented from being cancelled due to crew availability.DiscussionThe benefit and cost elements used in the socio-economic analysis contain an estimated benefit of the measure, based on the valuation of life years gained for a limited number of patients. The prerequisites for life years gained, with the associated monetary value for quality-adjusted life years, are important for the outcome of the cost-benefit analysis. In this study 6.95 life years gained is used as basis for the benefit of the measure. This number is based on the conclusion of two studies, which have studied the benefits of HEMS helicopters staffed with a doctor in Norway.In a cost-benefit analyses, a quantification shall as far as possible be made in monetary values of all the positive and negative effects the measure entails. In this analysis, one criticism may be that these effects are relatively few, the investment costs (the increased operating costs) are not provided a detailed description of, and other factors such as; effect on the environment, risk of simultaneous requirements of the HEMS helicopter with possible negative effect for the patient who most needs it, likelihood of accidents with associated negative effect are neither included in the cost-benefit analysis.ConclusionAlternations to the working and resting periods for Norwegian HEMS operations that will result in a change from the current 24-h, continuous emergency readiness with the same crew, to a set-up with two, and up to three, different crews are not found to be socio-economically beneficial.

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.

HEMS in Alpine Rescue for Pediatric Emergencies

The objective of this study was to describe the pediatric emergencies encountered by the Christophorus-1 helicopter emergency medical service (HEMS) during a period of 2 years. Emergency treatment of pediatric casualties by HEMS was evaluated at a helicopter base. Children up to 14 years who were treated by HEMS emergency physicians from Christophorus-1 during primary missions in the alpine region were retrospectively enrolled. Of the 1314 HEMS operations conducted during a 2-year investigation period, pediatric emergencies accounted for 114 (8.7%). Trauma was the most common emergency indication (91.3%) in alpine areas, and 77.5% of the indications were related to skiing and snowboarding; 11.3% of the prehospital pediatric emergencies were classified as life-threatening. Interventions on site were rendered in 46.3% of cases. Mean and SD intervals for approach were 11.0 ± 3.0 minutes; for treatment, 14.0 ± 6.0 minutes; and for transport, 8.0 ± 4.0 minutes. Intervals on site were significantly longer whenever it was necessary to search for an interim landing place (P < .001) or perform rope extrication (P < .001). Aggravating environmental conditions such as low temperature (78.8%), rocky terrain (18.8%), or precipitation (12.5%) were common. Rapid procedures are preferred to sustained on-scene treatment, particularly when surrounding conditions are hostile. HEMS emergency physicians attempt to keep on-site intervals short and treatment and monitoring to the essential to minimize delay in rescue.

The Hypoxia Alarm of a Multigas Analyzer Is Triggered During Helicopter Takeoffs in Helicopter Emergency Medical Services Operations

ObjectiveSafety in helicopter emergency medical services (HEMS) settings might be enhanced by the routine use of portable multigas analyzers to indicate hypoxic ambient air mixtures and the presence of hazardous gases. MethodsIn our HEMS (EC-135, Lifeliner 1, Amsterdam, The Netherlands), we introduced a professional multigas analyzer (Gas Alert Max XT II; Honeywell Analytics, Lincolnshire, IL) to prospectively detect possible hazardous gas mixtures. This analyzer measures ambient oxygen percentage (FO2, 0%-30%), carbon monoxide (CO, 0-1,000 ppm), hydrogen sulfide (H2S, 0-200 ppm), and combustibles (lower explosive limit, %). ResultsBefore 12 HEMS flights, we measured a stable baseline ambient FO2 of 20.9%. However, in all flights, takeoff to cruising altitude (500-1,000 ft) markedly decreased the measured FO2 to 19.1% ± 0.1% (mean ± standard deviation; Wilcoxon signed rank test, P = .002) with a minimum of 18.8%. This triggered the optoacoustic hypoxia alarm (preset to 19.5% to comply with international guidelines) in all cases. Maintaining cruise altitude restored measured FO2 slowly back to 20.9%. In contrast, CO, H2S, and combustibles remained unchanged during takeoff and flight. ConclusionsThe hypoxia alarm of multigas analyzers is reproducibly triggered during helicopter takeoff. This observation may be explained by properties of certain multigas analyzers using a capillary controlled concentration sensor for FO2 measurement. Flight crews, increasingly equipped with those multigas analyzers, should be aware of this fact.

Perceptions and culture of safety among helicopter emergency medical service personnel in the UK

BackgroundThe use of helicopter emergency medical services (HEMS) has increased significantly in the UK since 1987. To date there has been no research that addresses HEMS pilots and medical crews'...

Civilian Helicopter Search and Rescue Accidents in the United States: 1980 Through 2013

Helicopters are commonly used in search and rescue operations, and accidents have occurred during helicopter search and rescue (HSAR) missions. The purpose of this study is to determine whether the civilian (ie, neither Department of Defense nor Department of Homeland Security) HSAR accident rate in the United States can be established and if any common contributing factors can be identified. Searches of the National Transportation Safety Board aviation accident database, the records of major search and rescue and air medical organizations, and the medical and professional literature for reports of HSAR accidents were conducted. A total of 47 civilian HSAR accidents were identified during the study period. Of these, 43% (20 of 47) involved fatal injuries, compared with 19% (1390 of 7221) for US general helicopter aviation accidents, and 40% (105 of 260) for US helicopter emergency medical services accidents during the same period. Accidents occurring at night had a higher percentage of fatalities, 67% (8 of 12), than did those occurring during daylight, 33% (12 of 35). The majority of accidents occurred under visual meteorological conditions, but all 3 accidents occurring under instrument meteorological conditions resulted in fatal injuries. The total number of HSAR missions conducted annually could not be established. Although the overall number of HSAR accidents in the United States is small, the percentage of fatal outcomes from HSAR accidents is more than twice that for general helicopter aviation accidents, and is comparable to that seen in helicopter emergency medical services operations. Accidents occurring during darkness or under instrument meteorological conditions had a higher percentage of fatalities. A limitation of this study is that the total number of HSAR missions conducted annually in the United States could not be established, so an overall accident rate cannot be calculated. Further study could help to improve the safety of flight in the HSAR environment.

Civilian Helicopter Search and Rescue Accidents in the United States: 1980 Through 2013

Helicopters are commonly used in search and rescue operations, and accidents have occurred during helicopter search and rescue (HSAR) missions. The purposes of this study were to investigate whether the HSAR accident rate in the United States could be determined and whether any common contributing factors or trends could be identified. Searches were conducted of the National Transportation Safety Board aviation accident database, the records of the major search and rescue and air medical organizations, and the medical and professional literature for reports of HSAR accidents. A total of 47 civilian HSAR accidents were identified during the study. Of these, 43% involved fatal injuries, compared with a 19% fatality rate for US helicopter general aviation accidents during the same time period and a 40% rate for helicopter emergency medical services. The HSAR accidents carried a significantly higher risk of fatal outcomes when compared with helicopter general aviation accidents (2-tailed Fisher's exact test, P < .0005). Accidents that occurred at night and under instrument meteorological conditions did not have a statistically significant increase in percentage of fatal outcomes (P > .05). The number of HSAR missions conducted annually could not be established, so an overall accident rate could not be calculated. Although the overall number of HSAR accidents is small, the percentage of fatal outcomes from HSAR accidents is significantly higher than that from general helicopter aviation accidents and is comparable to that seen for helicopter emergency medical services operations. Further study could help to improve the safety of HSAR flights.

Pilots' age and incidents in helicopter emergency medical services: a 5-year observational study.

Helicopter emergency medical services (HEMS) are considered to have a higher risk of incidents compared to other airborne operations. As HEMS poses high cognitive demands, age-related cognitive changes of helicopter pilots might become a safety risk. The aim of this study was to estimate the association between the age of pilots and incidents in HEMS. We conducted a retrospective observational study of incidents during HEMS operations of one Austrian and two German air rescue organizations between 2007 and 2011. The sample included 257 regularly operating HEMS pilots. Age of the pilots varied between 44.52 yr (SD = 7.80) in 2007 and 46.57 yr (SD = 8.14) in 2011. Incidents were categorized as the number of HEMS operations with at least one liability damage (LD). Statistical analyses used multilevel growth curve modeling with generalized linear mixed models. 1770 LD were observed during 402.372 HEMS operations (approximately four LD per 1000 operations). From 2007 to 2011 the average number of LD per year varied between M = 0.95-1.77 for pilots < 35 yr to M = 0.25-1.53 for pilots > or = 60 yr. There was no statistically significant main effect of pilot's age on the number of LD. There was a trend of an interaction effect between age and time, which suggests that pilots with higher age tended to be involved in slightly fewer LD with time than younger pilots. In sum, findings provide no evidence that older pilots have a higher risk than younger pilots of being involved in an incident during HEMS operations.

A 26-year comparative review of United Kingdom helicopter emergency medical services crashes and serious incidents

The use of helicopter emergency medical services (HEMS) has increased substantially in the United Kingdom since 1987. There are currently no data on the rate of crashes and serious incidents related to HEMS in the United Kingdom. The aims of this article were to present data from a 26-year period since the start of HEMS operations in the United Kingdom and to compare them with published data from Germany, Australia, and the United States. Factors identified as affecting the safety of HEMS operations will also be discussed. A PubMed search was performed to retrieve published data on accident rates and safety discussions for international HEMS using the key words HEMS, helicopter, emergency medical services, accident, incident, and crash. The details of every helicopter crash in the United States since the beginning of HEMS operations was obtained and reviewed to identify those that involved HEMS aircraft. This novel UK information was compared with published data from three international systems. A total of 13 accidents or serious incidents involving HEMS aircraft were identified from Civil Aviation Authority records, only 1 of which was a fatal accident. It was estimated that approximately 230,000 HEMS missions occurred in the United Kingdom between 1987 and 2013, giving an absolute accident incidence of approximately 0.0057% and a fatal accident incidence of approximately 0.00043%. The accident and fatal accident rate per 10,000 missions in the United Kingdom was 0.57 and 0.04, respectively. This compares with published rates from Germany, Australia, and the United States with accident rate per 10,000 missions ranging between 0.57 and 0.75 and fatal accident rates per 10,000 missions ranging between 0.04 and 0.23. Accidents and serious incidents relating to HEMS operations in the United Kingdom have been comprehensively identified for the first time, allowing an estimation of overall accident and fatal accident rates and comparison with other countries' HEMS operations. Data collection and analysis were hampered by obscurity of data sources and poor availability of data. In a time of increasing HEMS use in the United Kingdom, it is essential to be mindful of safety, and standardization of data collection will improve focus in this important area.

A stroke in the woods

Responding to incidents where access by conventional land-based ambulance assets is limited is an important facet of helicopter emergency medical services operations in rural areas. Often in such cases extra...

An investigation into the cost, coverage and activities of Helicopter Emergency Medical Services in the state of New South Wales, Australia

Background and context Helicopter Emergency Medical Services (HEMS) have been incorporated into modern health systems for their speed and coverage. In the state of New South Wales (NSW), nine HEMS operate from various locations around the state and currently there is no clear picture of their resource implications. The aim of this study was to assess the cost of HEMS in NSW and investigate the factors linked with the variation in the costs, coverage and activities of HEMS. Methods We undertook a survey of HEMS costs, structures and operations in NSW for the 2008/2009 financial year. Costs were estimated from annual reports and contractual agreements. Data related to the structure and operation of services was obtained by face-to-face interviews, from operational data extracted from individual HEMS, from the NSW Ambulance Computer Aided Despatch system and from the Aeromedical Operations Centre database. In order to estimate population coverage for each HEMS, we used GIS mapping techniques with Australian Bureau of Statistics census information. Results Across HEMS, cost per mission estimates ranged between $9300 and $19,000 and cost per engine hour estimates ranged between $5343 and $15,743. Regarding structural aspects, six HEMS were run by charities or not-for-profit companies (with partial government funding) and three HEMS were run (and fully funded) by the state government through NSW Ambulance. Two HEMS operated as ‘hub’ services in conjunction with three associated ‘satellite’ services and in contrast, four services operated independently. Variation also existed between the HEMS in the type of helicopter used, the clinical staffing and the hours of operation. The majority of services undertook both primary scene responses and secondary inter-facility transfers, although the proportion of each type of transport contributing to total operations varied across the services. Interpretation This investigation highlighted the cost of HEMS operations in NSW which in total equated to over $50 million per annum. Across services, we found large variation in the cost estimates which was underscored by variation in the structure and operations of HEMS.

Use of Geographic Information Systems to Determine New Helipad Locations and Improve Timely Response While Mitigating Risk of Helicopter Emergency Medical Services Operations

Introduction. Traumatic injury is a leading cause of morbidity and mortality, but these can be minimized by timely transport to definite care. Helicopter emergency medical services (HEMS) provide timely transport and can influence survival. However, accident analyses indicate that landing at an unsecured landing zone (LZ), particularly at night, increases the risk of aviation accidents. To ensure safety, some HEMS operations land only at designated, secured LZs. Objective. This study utilized geographic information systems (GISs) to compare locations of scene call requests and secure LZs. The goal was to determine the optimal placement of new helipads as a strategy to improve access while mitigating the risk of aviation accidents. Methods. Call request data from a large air medical transport service were used to determine the geographic locations of all requests for scene responses in 2006. Request locations were compared with the locations of existing helipads, and straight-line distances between scene and helipad were determined using the GIS application. The application was then used to determine potential locations for new helipads. Results. During the study period, 748 requests for scene calls and 269 helipads were available. There were 476 (52.4%) requests at least 10 kilometers from a helipad and 356 (36.6%) requests at least 15 kilometers from a helipad. One particular region, Southwestern Ontario, was identified as having the highest number of requests >15 kilometers from the closest helipad. Conclusion. GISs can be used to determine potential locations for new helipad construction using historical call request data. This evidence-based approach can improve HEMS access while mitigating operational risk.

Helicopter Air Medical Transport Safety: What is the Role of the Emergency Nurse?

At the time this article was being prepared, there had been 12 helicopter emergency medical services (HEMS) accidents claiming 35 lives and injuring 6 people during the preceding 12 months, the worst safety record in the history of the air medical industry. 3 Data compiled from the Concern Network Archives. Google Scholar Throughout the history of the industry, HEMS operations have had a higher accident rate than other types of helicopter operations. 4 Blumen IJ The University of Chicago Aeromedical Network Safety CommitteeA safety review and risk assessment in air medical transport (supplement to the air medical physician handbook). Air Medical Physicians Association, Salt Lake City2002: 24 Google Scholar The air medical transport industry in North America has grown from a single hospital-based helicopter program in 1972 to 267 HEMS programs in 2007, operating a total of more than 800 helicopters. 5 Atlas and Database of Air Medical Services. Google Scholar Gordon H. Worley, Member, California Chapter, is Flight Nurse, REACH Air Medical Services, Santa Rosa, CA.

Helicopter emergency medical service in out-of-hospital cardiac arrest--a 10-year population-based study.

In 1988, Norway established a countrywide, physician staffed helicopter emergency medical service (HEMS). The medical benefit remains controversial. The aim of this study was to estimate the population incidence of HEMS involvement in out-of-hospital cardiac arrest, report the patient outcome and evaluate the contribution of HEMS to survival. We studied HEMS operations in central Norway (population 364,000) during a 10-year period (1988-1997). Missions were classified according to type and quality of intervention done by the primary care providers. HEMS witnessed cardiac arrests were not considered. Patient outcome was determined as survival to hospital discharge with cerebral performance category (CPC) score. The contribution made by HEMS in each survivor was assessed from the timing of return of spontaneous circulation (ROSC) and from subsequent need for advanced medical intervention. The relation between survival and HEMS response time was investigated by ordinal correlation. A total of 541 requests (14.9 per 100,000 inhabitants per year) were identified, of which 424 missions were completed. Overall survival to discharge was 36/541 (6.6%), yielding a population survival incidence of 1 per 100,000 per year. Ninety-five percent of survivors made a favourable cerebral outcome (CPC 1 or 2). General practitioners/ambulance personnel resuscitated 29 out of 36 survivors. The remainder achieved ROSC after HEMS arrival. Case by case, HEMS assistance was considered possibly important in 17 survivors. We found no relation between survival and HEMS response time (P=0.77). Survival following out-of-hospital cardiac arrest assisted by HEMS in this region is low, but not negligible. While primary care is most important, HEMS may possibly contribute to the additional survival of 0.19 to 0.46 patients per 100,000 per year. This benefit appears to be independent of HEMS response time.