Helicopter Emergency Medical Services Programs Research Articles

Feasibility of 10-Minute Arrival Time to Departure Time Metric for STEMI Patients

Objectives Delays in reperfusion treatment in ST-elevation myocardial infarction (STEMI) patients leads to higher morbidity and mortality. Previous reports for Helicopter Emergency Medical Services (HEMS) suggests a 10-minute skid-to-skid (arrival to departure) time to achieve appropriate reperfusion times. However, there is no published data on whether this goal is achievable for a HEMS service. This study aims to see if a midwestern critical care service can consistently achieve a 10-minute helicopter skid-to-skid time or ground critical care service arrival to departure time. Further, comparing this metric between ground and helicopter transportations will help evaluate the ideal transportation method to optimize time to percutaneous intervention (PCI). Methods This was a retrospective chart review utilizing 10 years of data from our ground and HEMS program to assess whether a 10-minute arrival to departure time for STEMI patients could be achieved. Patients included were at least 18 years of age and were transported from the referring facility for further STEMI management. Wilcoxon rank sum test and Chi-square tests were used to evaluate data between helicopter and ground services. Results Included in the study were 686 patients, 608 by helicopter transport and 78 by ground transport. The median arrival to departure time was 14 min (IQR = 5) for helicopter patients and 13 min (IQR = 6) for ground patients. There was not a statistically significant difference in this metric for STEMI patients transported by helicopter versus ground. A statistically significant difference, though, existed between helicopter and ground transports among percent with times less than or equal to 10 min versus percent times greater than 10 min, X2 = 5.46, df = 1, p = 0.02. Two referring facilities had statistically significant differences in median arrival to departure times. Conclusions Our study found that a median EMS arrival to departure time of 10 min to transport STEMI patients was not consistently achieved via either helicopter or ground transportation.

Out-of-pocket payments made by patients transported by Helicopter Emergency Medical Services (HEMS)

ObjectiveRecent news media have reported that Helicopter Emergency Medical Service (HEMS) programs use the practice of balanced billing, resulting in exorbitant charges not covered by insurance companies and financially burdening patients. To date, no study has described the billing practices of HEMS programs. We look to provide transparent billing practices and average patient payment of one midwestern non-profit HEMS program and report the reimbursement data of both federal and private insurance policies for transports. MethodsCollated billing data were obtained from a HEMS program for two time periods from January 2017 through June 2018 (P1) and July 2018 through December 2019 (P2). From P1 to P2 the base charge per transport was increased. All transports that generated a bill during the periods were included and descriptive statistics were used to depict the findings. ResultsPer flight, base charge was $19,158 in P1 and $33,023 in P2. On average, patients paid $158.09 and $178.99 out-of-pocket, respectively. Reimbursement practices of insurance companies varied widely across time periods and among each other. ConclusionThe amount charged by this HEMS program and amount patients paid on average for flights was less than has been commonly reported in recent news media. More transparency in costs and payments between non-profit and for-profit HEMS agencies should occur.

Hemodynamics in Helicopter Emergency Medical Services (HEMS) Patients Undergoing Rapid Sequence Intubation With Etomidate or Ketamine.

Rapid sequence intubation (RSI) is performed by helicopter emergency medical services (HEMS) providers to establish airway control. Common induction agents are etomidate and ketamine, both touted to have relatively stable hemodynamic profiles. Limited data comparing these medications in the air medical setting exist. Compare administration of ketamine and etomidate on peri-intubation hemodynamics. A retrospective chart review of intubations performed by a HEMS program over 69 months was completed. Heart rate (HR) change, systolic blood pressure (SBP) change, and hypotension with etomidate or ketamine use were measured. There were 258 patients induced with etomidate and 48 with ketamine. Etomidate patients showed a +1.161% change in HR (SD ± 22.7) and -0.49% change in SBP (SD ± 25.0). Ketamine patients showed a -4.7% change in HR (SD ± 16.7) and 17.2% change in SBP (SD ± 43.4). The p-values for percentage change in HR and SBP between etomidate and ketamine were 0.0830 and 0.0018, respectively. Twenty-five episodes of postadministration hypotension occurred with etomidate, and two with ketamine (p=0.028). Both ketamine and etomidate are appropriate for intubation of HEMS patients. Ketamine was preferentially selected for hypotensive patients with statistically significant improvement in SBP. Although statistically significant, both ketamine and etomidate had relative low incidences of hypotension.

Direct Versus Video Laryngoscopy in a Helicopter Emergency Medical Services Setting: A Retrospective Comparison

ObjectiveSince the introduction of video laryngoscopy (VL) as a technique for orotracheal intubation, its use has become widespread among prehospital providers. However, little information is available about the efficacy and success of VL compared with direct laryngoscopy (DL) in the helicopter emergency medical services (HEMS) setting. The objective of this study was to investigate whether VL or DL increased successful first-pass orotracheal intubations and overall intubation success by HEMS providers. DesignA retrospective chart review was performed on adults intubated by a HEMS program from January 2015 to July 2017. All orotracheal intubations with at least 1 attempt were included. Excluded were emergent cricothyrotomies, nonintubated patients, and those intubated before HEMS care. ResultsDL accounted for 21 intubations, whereas VL was used for 150 intubations. Nineteen of 21 (90.5%) DL intubations were successful on first pass, whereas 127 of 150 (84.7%) VL intubations were successful on first pass. The overall success rate was 90.5% for DL and 92.7% for VL. For both first-pass and overall success rates, the differences between modalities were not statistically significant. DL and VL had nearly identical complication rates, with hypoxia being the primary complication in both groups. ConclusionNo statistically significant difference was found in the first-pass rate, the overall success rate, or complications between DL and VL.

Factors That Contribute to Provider Decision Between Direct and Video Laryngoscopy in a Helicopter Emergency Medical Services System: A Survey

ObjectiveIn caring for critically ill patients in the prehospital setting, rapid, definitive airway management is a high-risk, crucial procedure. All helicopter emergency medical services (HEMS) providers must proficiently and safely perform this procedure. Little information is available about the preference and efficacy of video laryngoscopy (VL) compared with direct laryngoscopy (DL). Additionally, there is a paucity of research investigating which method of intubation is more successful in the HEMS setting. The objective of this study was to delineate factors that contribute to provider decision regarding the method of orotracheal intubation and compare the frequency of use for each method. MethodsAn anonymous online survey was distributed to all providers in a single HEMS program. The survey results were deidentified and blinded to the researchers. ResultsThe survey was sent to 40 HEMS providers; 29 responded, and 119 total intubations were reported. Method familiarity and patient condition were the most commonly cited reasons for choosing both DL and VL for intubation. DL accounted for 15 intubation attempts, whereas 104 attempts were completed by VL. ConclusionFor both laryngoscopy techniques, the top reasons cited for selecting an intubation technique were being comfortable with that technique and patient presentation. Further investigation with chart review would help confirm the reported data.

Effectiveness of Surgical Airway Training Lab and Assessment of Skill and Knowledge Fade in Surgical Airway Establishment Among Prehospital Providers

Study Objective This study sought to establish effectiveness of a current surgical airway education program comprised of lecture based and hands on training utilizing cadavers. The secondary aim was to evaluate the presence and degree of knowledge and skill fade three months after the training. Methods Thirteen participants were recruited from an academic medical center-based helicopter emergency medical services program. Participants were assessed prior to training, immediately after training and three months after training using a multiple-choice exam and a timed evaluation of ability to establish a surgical airway on a pig trachea. Demographic data were interpreted to assess the impact of years of experience on knowledge and skill. Results Training was effective at increasing knowledge and skill, with a significant mean increase in multiple choice exam scores of 14.6 percentage points following training and a mean decrease in time to airway establishment of 26 seconds. The training was not consistently effective at yielding the ability to establish a surgical airway in less than a threshold of 40-seconds, with only 46% of participants able to do so. There was no evidence of statistically significant knowledge or skill fade at three months post training. Conclusion Surgical airway training which includes both didactic and clinical learning utilizing human cadavers is effective at increasing both knowledge, as evidenced by increased scores on a multiple-choice exam, and skill as indicated by a decrease in time necessary to establish a patent surgical airway. Additional training is needed to establish competency in consistently establishing surgical airways in less than 40-seconds. While no significant knowledge or skill fade is present at three months post training, further studies are needed to determine the time interval at which knowledge and skill fade become significant, and at what frequency training should occur to prevent such fade. This study sought to establish effectiveness of a current surgical airway education program comprised of lecture based and hands on training utilizing cadavers. The secondary aim was to evaluate the presence and degree of knowledge and skill fade three months after the training. Thirteen participants were recruited from an academic medical center-based helicopter emergency medical services program. Participants were assessed prior to training, immediately after training and three months after training using a multiple-choice exam and a timed evaluation of ability to establish a surgical airway on a pig trachea. Demographic data were interpreted to assess the impact of years of experience on knowledge and skill. Training was effective at increasing knowledge and skill, with a significant mean increase in multiple choice exam scores of 14.6 percentage points following training and a mean decrease in time to airway establishment of 26 seconds. The training was not consistently effective at yielding the ability to establish a surgical airway in less than a threshold of 40-seconds, with only 46% of participants able to do so. There was no evidence of statistically significant knowledge or skill fade at three months post training. Surgical airway training which includes both didactic and clinical learning utilizing human cadavers is effective at increasing both knowledge, as evidenced by increased scores on a multiple-choice exam, and skill as indicated by a decrease in time necessary to establish a patent surgical airway. Additional training is needed to establish competency in consistently establishing surgical airways in less than 40-seconds. While no significant knowledge or skill fade is present at three months post training, further studies are needed to determine the time interval at which knowledge and skill fade become significant, and at what frequency training should occur to prevent such fade.

Effectiveness of Surgical Airway Training Laboratory and Assessment of Skill and Knowledge Fade in Surgical Airway Establishment Among Prehospital Providers

ObjectiveThis study aimed to evaluate the effectiveness of surgical airway education composed of training using cadavers. The secondary aim was to evaluate the presence and degree of knowledge and skill fade 3 months after training. MethodsThirteen participants were recruited from a helicopter emergency medical services program. Participants were assessed at multiple points during training using a multiple-choice examination and a timed evaluation of the ability to establish a surgical airway. ResultsTraining was effective at increasing knowledge and skill, with a mean increase in multiple-choice examination scores of 14.6 percentage points after training (P < .01) and a mean decrease in time to airway establishment of 26 seconds (P < .01). The training was not associated with the ability to establish a surgical airway in less than 40 seconds, with only 46% of participants able to do so. There was no evidence of knowledge or skill fade at 3 months after training. ConclusionSurgical airway training that includes both didactic and clinical learning using human cadavers is effective at increasing both knowledge and skill. Additional training is needed to establish competency in consistently performing surgical airways in less than 40 seconds. No knowledge or skill fade was present at 3 months after training.

Abstract 5: Prevalence, Characteristics, and Accuracy of Stroke Diagnosis for Scene Transports to a Comprehensive Stroke Center by Helicopter Emergency Medical Services: A One Year Retrospective Evaluation

Ischemic strokes affect 795,000 people per year in the US and are a major cause of long-term disability and mortality. These patients are often assessed by EMS at the scene and transported to appropriate centers of care for further evaluation and treatment. Utilization of helicopter emergency medical services (HEMS) greatly improves access to comprehensive stroke centers (CSC). However, the number of patients who have been air lifted from scene calls to a single CSC for suspected stroke with a non-stroke final diagnosis remains unclear. In this retrospective observational study, we aim to determine the volume and demographics of patients with suspected stroke and subsequently transported via HEMS from scene to a CSC. Between January 1, 2017 and December 31, 2017, 717 prehospital records of patients airlifted by a two-helicopter program from scene calls to a single CSC were analyzed for stroke alerts. Final diagnosis was determined from EMR. No patients were excluded. Parameters such as patient home county, age, race, sex, and transport times were collected from prehospital charts. Home counties were categorized according to the CDC Urban-Rural Classification Scheme for Counties. Counties were classified as one of four urban-rural designations: Large Central Metro, Large Fringe Metro, Medium/Small Metro and Nonmetro. In 2017, of the 717 airlifted patients, 37 patients were airlifted from on-scene calls and suspected of stroke. Demographics of these suspected stroke patients include 49% African American (18), 49% White, Non-Hispanic (18) and 2% White, Hispanic (1). Most airlifted patients were home to rural counties (84%, 31) indicated as “Nonmetro”. Of the 37 patients suspected of stroke by EMS, 32% were diagnosed with ischemic stroke (12), 19% were diagnosed with intracerebral hemorrhage (7) and 8% were diagnosed with transient ischemic attack (3). 41% of the suspected ischemic stroke patients had a final diagnosis which was not stroke related and were admitted for other medical conditions (15). Demographics of the 15 stroke mimics included 47% African American (7) and 53% White, Non-Hispanic (8). Our analysis revealed that 84% (31/37) transported to a CSC via HEMS from scene calls suspected of stroke were home to rural counties, classified as “Nonmetro”. Patients in rural counties are inherently at risk for increased stroke mortality due to geographic isolation from centers of higher stroke care. In our sample, HEMS appears to be most utilized by the rural population for stroke care and may help address the lack of access to advanced stroke services. Demographics did not vary between patients with true strokes and stroke mimics. Of all suspected stroke patients airlifted from scene to a CSC, 22 were true strokes and 15 were stroke mimics. Although this study has numerous limitations including small sample size, retrospective methodology, and from a single CSC, it suggests that HEMS may serve to equalize the barriers to access for timely and definitive stroke interventions in rural populations. Future analyses should consider including multiple CSCs and HEMS programs to determine the generalizability of these findings.

Variability of Uncrossmatched Blood Use by Helicopter EMS Programs in the United States

Study Objective: Some helicopter emergency medical services (HEMS) maintain an independent supply of blood for use during transport, although practice is variable and not well described. We aimed to characterize the blood-carrying practices by HEMS programs across the United States. Methods: Online surveys were sent to the leadership of the 261 HEMS programs nationwide listed in the 2011 Atlas and Database of Air Medical Services (ADAMS) database. We examined blood-carrying practices in aggregate, including typical transport time, proportion of scene transports, and local population density. A GIS (Geographic Information System) and multivariable logistic regression models were used to estimate the impact of characteristics of local practice on each program's decision to carry blood. Results: A total of 235 (91%) programs responded to the survey, representing 857 of the 929 (92.2%) HEMS rotor wing aircraft nationwide. Fifty-nine (25.3%) programs independently carried blood. A higher proportion of interfacility transports (OR 1.023; 95% CI 1.010–1.036) and decreased local population density (OR 1.006; 95% CI 1.001–1.011) were associated with increased odds of carrying blood. Transport time (OR 1.006; 95% CI 0.991–1.020) and number of transports (OR 1.000; CI 1.000–1.000) were not associated with a program's blood carrying practices. There was no effect of local practices on a program's decision to carry blood (OR 1.002; 95% CI 0.980–1.026). Conclusion: There is great variability in the utilization of blood by HEMS programs in the United States. Programs that serve more rural areas and programs with a larger percentage of interfacility transports are more likely to independently carry blood.

Hemodynamic consequences of ketamine vs etomidate for endotracheal intubation in the air medical setting

ObjectiveRecent drug shortages have required the occasional replacement of etomidate for endotracheal intubation (ETI) by helicopter emergency medical services (HEMS), with ketamine. The purpose of this study was to assess whether there was an association between ketamine vs etomidate use as the main ETI drug, with hemodynamic or clinical (airway) end points. MethodsThis retrospective study used data entered into medical records at the time of HEMS transport. Subjects, 50 ketamine and 50 etomidate, were accrued from 3 US HEMS programs. The study period was from August 2011 through May 2012. Data collection included demographics, diagnostic category, ETI drugs use, ETI success, and complications. Hemodynamic parameters were assessed for up to 2 sets of vital signs before airway management and up to 5 sets of post-ETI vital signs. Significance was defined at the P < .05 level. ResultsPatients on ketamine and etomidate were similar (P > .05) with respect to age, sex, scene/interfacility mission type, trauma vs nontrauma, neuromuscular blocking agent use, and rates of coadministration of fentanyl or midazolam. All patients had successful airway placement. Peri-ETI hypoxemia was seen in 10% of etomidate and 16% of ketamine cases (P = .55). The pre-ETI and post-ETI were similar between the ketamine and etomidate groups with respect to systolic blood pressure and heart rate at every vital signs assessment after ETI. ConclusionInitial assessment of ETI success and complication rates, as well as peri-ETI hemodynamic changes, suggests no concerning complications associated with large-scale replacement of etomidate with ketamine as the major airway management drug for HEMS.

Logistical Concerns for Helicopter Emergency Medical Services Response to the Injured Police Officer

IntroductionAlthough infrequent, helicopter emergency medical services (HEMS) have been activated to transport police officers injured in the line of duty. The purpose of this study was to query current industry operating procedures in terms of law enforcement training and operations, specifically in terms of firearms restrictions and cotransport of injured officers and suspects. MethodsThis is a survey-based study of air medical emergency medical services program managers in 2010. Descriptive statistics and the Fisher exact test were used to analyze the results. ResultsFifty-eight programs (78.4%) reported transporting officers injured in the line of duty. Sixty-three respondents (85.1%) maintained a written policy addressing the presence of weapons aboard the aircraft; 58.8% of respondents replied that this restriction applied to sworn law enforcement personnel on active duty. Nearly a quarter of programs with written firearms policies have not informed the law enforcement agencies affected by these policies. Two programs reported having cotransported an injured officer and a suspect. ConclusionHEMS will continue to play an important role in the care and transportation of injured officers. HEMS programs may have specific policies that impact law enforcement operations. Open communication of these policies and interagency training are critical to effective interaction during high-stress incidents.

Helicopter Emergency Medical Services Crew Administration of Antibiotics for Open Fractures

This study had 3 major aims: (1) to ascertain the degree to which helicopter emergency medical services (HEMS) administration of antibiotics (Abx) can streamline the time to Abx in open fracture patients, (2) to determine whether any clinical outcome improvements were associated with HEMS Abx therapy, and (3) to calculate the cost-effectiveness of prehospital HEMS Abx. The design of the study was a prospective, nonrandomized, nonintervention, natural study of timing and clinical outcomes for patients with suspected open extremity fracture. There were 138 scene trauma cases transported by 8 participating HEMS programs from July 2009 to June 2010. The participating HEMS programs were both urban and rural. The diagnosis of an open fracture by the HEMS crews had an accuracy rate of 97.8% (95% confidence interval, 90.8%–98.4%). The time from the incident to Abx was 30 minutes shorter (P = .0001) when Abx were administered by HEMS crews. There was no statistical significance (P = 1.0) regarding the endpoint of infection or nonunion development in HEMS- versus hospital-administered Abx. In conclusion, the administration of Abx by HEMS crews to patients diagnosed with open extremity fractures is feasible, it may decrease the time to Abx by 30 minutes, and the effect magnitude (40.3% relative risk reduction) was promising.

A prospective review of the use of ketamine to facilitate endotracheal intubation in the helicopter emergency medical services (HEMS) setting

IntroductionKetamine is a dissociative agent used for sedation and intubation in various clinical settings. Despite its proven haemodynamic safety, ketamine has not been widely used in prehospital medicine. This study...

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.

Survey-based research: Performing the survey

Survey-based research: Performing the survey

Helicopter Scene Response: Regional Variation in Compliance with Air Medical Triage Guidelines

Background. Our state has consensus guides for helicopter emergency medical services (HEMS) scene dispatch, based on physiologic, anatomic, andspecial criteria (e.g., ejection from a vehicle, age < 10 or > 55 years). There has been much attention paid to improving HEMS triage criteria, but less focus on whether current HEMS uses meet existing criteria. Objectives. To assess a HEMS program's compliance with regional air medical dispatch guidelines andto identify factors associated with noncompliant flights. Methods. Using chart review anddiscussion with referring agencies, we conducted a consecutive case review of a HEMS program's initial 100 flights in one year (2005), collecting data pertinent to triage, prehospital times, andhospital course. Analysis (p = 0.05) of the outcome “met triage criteria” (MTC) used Kruskal-Wallis andFisher's exact tests. Logistic regression, reporting odds ratios (ORs) with 95% confidence intervals (CIs), was used to adjust for covariates while assessing predictors of the dichotomous outcome MTC. The predictors assessed included demographics, advanced life support (ALS) scene presence, andwhether transports occurred during rush hours (0700–1000 and1600–1900). Results. The 100 patients (98 blunt trauma; 73% male) from four Massachusetts emergency medical services (EMS) regions (n = 94) andNew Hampshire (n = 6) were classified as MTC in 73% of cases. Physiologic criteria were met in 19% of cases (they were the sole criterion met in one case), anatomic criteria in 49% (sole criterion n = 24), andspecial criteria in 67% (sole criterion n = 15). There was no association between MTC status andage (p = 0.98), gender (p = 0.39), rush-hour transport (p = 0.81), or ALS-trained ground EMS presence on scene (p = 0.98). Analysis adjusting for transport distance andinjury mechanism identified an association between EMS region andMTC transport status (p = 0.006); regions' likelihoods of MTC proportions ranged from 50% to 94%. Conclusion. Despite promulgation of consensus guidelines, nearly a fourth of HEMS transports were non-MTC. Wide interregional variation in the likelihood of MTC HEMS use provides a focus for further research/education. Regional systems should strive not only for the refinement of, but also the compliance with, HEMS triage guidelines.

Medically appropriate use of helicopter EMS: The mission acceptance/triage process

Introduction Appropriate use of helicopter emergency medical services (HEMS) ensures the maximum impact of a limited resource on improved health outcomes. Overtriage increases real and opportunity costs and may unjustifiably expose the program to small but inherent safety risks. The purpose of this study is to describe the mission acceptance process for an integrated, provincially based HEMS program and determine its utilization patterns. Methods This is a retrospective review of patient care and administrative databases. All missions were reviewed to determine whether they were medically appropriate. “Appropriateness” was defined a priori as requiring admission to a critical care unit, death during transportation or in first 24 hours, or in the case of trauma, an injury severity scale (ISS) score ≥ 12. Overtriage was defined as not meeting these a priori definitions. Results Five hundred eighty-four missions were reviewed from March 31, 2003 through December 31, 2004. Our mission acceptance process consists of three distinct but complementary phases: ongoing outreach education, scanning by dispatchers in an integrated dispatch center, and a clinician to online physician discussion about each case. The overall overtriage rate was 13.1%. Conclusion The rate of medically appropriate missions in this system is relatively high. Prospective research is required to improve HEMS triage systems.

Training of Residents for Their Role as Flight Physicians: A Survey of Emergency Medicine Training Programs

Objective: To determine the number of emergency medicine (EM) residency programs in which residents serve as helicopter emergency medical services (HEMS) crew, the extent of training provided for this role, and how HEMS residents are evaluated. Methods: Accredited EM residency programs were contacted by telephone to determine which programs had residents serving as HEMS physicians. A self‐administered survey was then mailed to the medical directors of the HEMS programs. Descriptive statistics were determined for each question. Results: Surveys were returned by 18 of the 20 residency programs (90%) where residents served as HEMS physicians. In the majority (94%), residents work with one other crew member, typically a nurse or paramedic. The amount of flight hours for a resident ranged from 25 to 500. The number of flights ranged from five to 225. The amount of HEMS training was highly variable. Four programs (22%) did not require any orientation flights with patients; 12 (67%) did not require any proficiency testing; direct attending supervision was rare (6%); and written feedback occurred in only 28% of programs. Conclusions: The training of residents for their role as flight physicians is highly variable, considering the amount of air transport time they perform. Direct faculty supervision, proficiency testing, and written feedback are rarely utilized.

Training of residents for their role as flight physicians: a survey of emergency medicine training programs.

To determine the number of emergency medicine (EM) residency programs in which residents serve as helicopter emergency medical services (HEMS) crew, the extent of training provided for this role, and how HEMS residents are evaluated. Accredited EM residency programs were contacted by telephone to determine which programs had residents serving as HEMS physicians. A self-administered survey was then mailed to the medical directors of the HEMS programs. Descriptive statistics were determined for each question. Surveys were returned by 18 of the 20 residency programs (90%) where residents served as HEMS physicians. In the majority (94%), residents work with one other crew member, typically a nurse or paramedic. The amount of flight hours for a resident ranged from 25 to 500. The number of flights ranged from five to 225. The amount of HEMS training was highly variable. Four programs (22%) did not require any orientation flights with patients; 12 (67%) did not require any proficiency testing; direct attending supervision was rare (6%); and written feedback occurred in only 28% of programs. The training of residents for their role as flight physicians is highly variable, considering the amount of air transport time they perform. Direct faculty supervision, proficiency testing, and written feedback are rarely utilized.

Assessment of U.S. helicopter emergency medical services' planning and preparedness for disaster response

Introduction: Helicopter emergency medical services (HEMS) roles in disaster response vary significantly from routine operation, and as reported in the literature, such responses have not been without difficulty. We identified nine criteria (written policy, triage and incident command training, disaster drill participation, ground and air communications plan, critical incident stress management, annual review, policy sharing) that may significantly affect an air medical program's disaster preparedness, response, and recovery. Of these criteria, a written policy is considered of primary importance. Methods: A written survey was developed and mailed in July 1995 to 187 U.S. rotor-wing members of the Association of Air Medical Services. The survey was designed to identify the programs that had a written policy and fulfilled the guideline criteria, had a written policy and partially fulfilled the criteria, or did not have a written policy. Results: Surveys were returned from 104 (56%) programs. Of the 103 qualifying respondents, 16 (16%) meet the criteria, 55 (53%) partially met the criteria, and 32 (31%) did not have written policies. Conclusion: Most U.S. HEMS programs have not fully addressed disaster preparedness, response, and recovery. HEMS disaster response guidelines should be established, and these criteria should be incorporated.