Helicopter Emergency Medical Services Transport Research Articles

Helicopter Emergency Medical Services (HEMS) Transportation Utilization for Acute Ischemic Strokes at a Community-Based Hospital in South Florida

Background: A comprehensive stroke center (CSC) servicing remote areas in South Florida became HEMS direct-from-field capable on October 15, 2020. This analysis reviews the utilization of this service and compares it to ground EMS (GEMS). Methods: This is a retrospective cohort study from October 15, 2020, to July 31, 2021, that collected HEMS adult stroke alert data and compared it to the prior year's summary GEMS stroke alert data. Using HEMS transportation logs, presenting stroke symptoms and prehospital assessment were abstracted, in addition to initial NIHSS, downgrade rate, stroke diagnosis percentage, treatment rate, and times. Results: The analysis included a total of 52 direct transport HEMS stroke alerts. Assessment tools utilized by HEMS included the Cincinnati stroke scale (4%) and the FAST-ED (37%); most cases (59%) did not document a stroke assessment tool. The median NIHSS was 10, with 37% presenting a score <6. Cases were downgraded upon arrival in 27% and after CT imaging in 15% of cases. Significantly (p<.001), more HEMS cases were diagnosed as stroke (69%) compared to GEMS (57%). Stroke treatment rates remained similar (HEMS=23%; GEMS=24%). Median door-to-needle times were significantly faster for HEMS (15 min) than GEMS (25 min) (p<.05). Median door-to-puncture times were clinically faster for HEMS (61mins) than GEMS (66 mins). Conclusion: Prehospital triage could be improved to better detect the 77% of patients who are not eligible for acute stroke reperfusion treatments and may benefit from ground as opposed to air transportation. The current HEMS triage, although not consistently documented, appropriately selects stroke victims, but not necessarily those who need air transport to a higher care level. Patients arriving via HEMS receive similar access to stroke treatment and, if treated, significantly faster treatment times.

Severity-Driven Trends in Mortality in a Large Regionalized Critical Care Transport Service

ObjectiveThe epidemiology accompanying helicopter emergency medical services (HEMS) transport has evolved as agencies have matured and become integrated into regionalized health systems, as evidenced primarily by nationwide systems in Europe. System-level congruence between Europe and the United States, where HEMS is geographically fragmentary, is unclear. In this study, we provide a temporal, epidemiologic characterization of the largest standardized private, nonprofit HEMS system in the United States, STAT MedEvac. MethodsWe obtained comprehensive timing, procedure, and vital signs data from STAT MedEvac prehospital electronic patient care records for all adult patients transported to UPMC Health System hospitals in the period of January 2012 through October 2021. We linked these data with hospital electronic health records available through June 2018 to establish length of stay and vital status at discharge. ResultsWe studied 90,960 transports and matched 62.8% (n = 57,128) to the electronic health record. The average patient age was 58.6 years ( 19 years), and most were male (57.9%). The majority of cases were interfacility transports (77.6%), and the most common general medical category was nontrauma (72.7%). Sixty-one percent of all patients received a prehospital intervention. Overall, hospital mortality was 15%, and the average hospital length of stay (LOS) was 8.8 days ( 10.0 days). Observed trends over time included increases in nontrauma transports, level of severity, and in-hospital mortality. In multivariable models, case severity and medical category correlated with the outcomes of mortality and LOS. ConclusionIn the largest standardized nonprofit HEMS system in the United States, patient mortality and hospital LOS increased over time, whereas the proportion of trauma patients and scene runs decreased.

Trauma patient transport to hospital using helicopter emergency medical services or road ambulance in Sweden: a comparison of survival and prehospital time intervals

BackgroundThe benefits of helicopter emergency medical services (HEMS) transport of adults following major trauma have been examined with mixed results, with some studies reporting a survival benefit compared to regular emergency medical services (EMS). The benefit of HEMS in the context of the Swedish trauma system remains unclear.AimTo investigate differences in survival and prehospital time intervals for trauma patients in Sweden transported by HEMS compared to road ambulance EMS.MethodsA total of 74,032 trauma patients treated during 2012–2022 were identified through the Swedish Trauma Registry (SweTrau). The primary outcome was 30-day mortality and Glasgow Outcome Score at discharge from hospital (to home or rehab); secondary outcomes were the proportion of severely injured patients who triggered a trauma team activation (TTA) on arrival to hospital and the proportion of severely injured patients with GCS ≤ 8 who were subject to prehospital endotracheal intubation.Results4529 out of 74,032 patients were transported by HEMS during the study period. HEMS patients had significantly lower mortality compared to patients transported by EMS at 1.9% vs 4.3% (ISS 9–15), 5.4% vs 9.4% (ISS 16–24) and 31% vs 42% (ISS ≥ 25) (p < 0.001). Transport by HEMS was also associated with worse neurological outcome at discharge from hospital, as well as a higher rate of in-hospital TTA for severely injured patients and higher rate of prehospital intubation for severely injured patients with GCS ≤ 8. Prehospital time intervals were significantly longer for HEMS patients compared to EMS across all injury severity groups.ConclusionTrauma patients transported to hospital by HEMS had significantly lower mortality compared to those transported by EMS, despite longer prehospital time intervals and greater injury severity. However, this survival benefit may have been at the expense of a higher degree of adverse neurological outcome. Increasing the availability of HEMS to include all regions should be considered as it may be the preferrable option for transport of severely injured trauma patients in Sweden.

A Retrospective Geospatial Simulation Study of Helicopter Emergency Medical Services’ Potential Time Benefit Over Ground Ambulance Transport in Northern South Africa

ObjectiveOne of the most important benefits of helicopter emergency medical services (HEMS) is a time benefit, either through expedited access to the casualty or a reduction in the transport time to definitive care. However, HEMS utilization does not come without risk to the public and crew or at an insignificant cost. Cost is an essential consideration for health policy decisions, especially in low- to middle-income countries, such as South Africa. The aim of this study was to determine whether there is a time benefit of HEMS dispatch in South Africa compared with simulated driving time. A secondary aim was to determine the distance from the incident site to the hospital at which a time benefit can be guaranteed. MethodsA retrospective study was undertaken by comparing the prehospital times of patients who underwent HEMS transportation with simulated ground emergency medical services (GEMS) transportation times. Handwritten patient records of actual flights were reviewed and analyzed. The actual flight times recorded were used to calculate the helicopter transport time, activation to scene time, scene time, and scene to hospital time. Times were assigned based on a nonsimultaneous dispatch model, as is used in South Africa. For each helicopter mission, Google Maps (Google Inc, Mountain View, CA) was used to simulate the fastest ground route from the same location of the incident to the same receiving hospital corrected for typical traffic trends. The actual HEMS and simulated GEMS times were compared using the paired t-test. Linear regression analysis was performed to determine a minimum driving distance at which HEMS provides a time benefit. ResultsA total of 118 HEMS transports were analyzed, the majority of which were trauma related (n = 115, 97%). HEMS transport resulted in a mean time deficit of −15 minutes (95% confidence interval, −18 to −11; P < .05) compared with simulated GEMS drive times. After regression, HEMS transport provides a time benefit at a driving distance greater than 119 km. ConclusionThe current study demonstrated that there was rarely a time benefit for actual primary emergency responses when HEMS was used compared with simulated driving time of GEMS transport. Using a nonsimultaneous dispatch model, a time benefit only occurs when the driving distance from the incident site to the hospital is greater than 119 km. There is an urgent need to critically evaluate HEMS utilization in the South African context.

Abstract TP5: Helicopter Emergency Medical Services (HEMS) Transportation Utilization For Acute Ischemic Strokes At A Community Based Hospital In South Florida

Background: Efficiency in the transfer of patients with ischemic stroke is a vital factor for patient prognosis. A comprehensive stroke center servicing remote areas in south Florida became HEMS direct-from-field capable on October 15, 2020. In some remote areas, the transfer of patients is via ground or air; the severity of the clinical presentation determines the mode. Concern about HEMS overutilization for lower stroke acuities prompted this study. Purpose: The purpose of this project was to evaluate the current HEMS stroke triage process, assess the accuracy of stroke diagnosis, and use this information to improve EMS education to prevent over-triage for stroke. Methods: A retrospective cohort study from October 15, 2020, to July 31, 2021, collected HEMS adult stroke alert data and compared it to the prior year's summary ground EMS (GEMS) stroke alert data. Using HEMS transportation logs, presenting stroke symptoms and pre-hospital assessment were abstracted. In addition, we evaluated initial NIHSS, downgrade rate, stroke diagnosis percentage, treatment rate, and times. Results: The analysis included a total of 52 HEMS stroke alerts. Assessment tools utilized by HEMS included the Cincinnati stroke scale (4%) and the FAST-ED (37%); the majority of cases (59%) did not document a stroke assessment tool. The median NIHSS was 10, with 37% presenting with a score &lt;6. Respectively, 6% and 15 % of cases were downgraded upon arrival and after CT imaging. Significantly (p&lt;.001), more HEMS cases were diagnosed as a stroke (69%) compared to GEMS (57%). Stroke treatment rates remained similar (HEMS=23%; GEMS=23%). Median door-to-needle times were significantly faster for HEMS (15min) than GEMS (25min) (p&lt;.05). Median door-to puncture times were significantly faster for HEMS (61mins) than GEMS (72mins) (p&lt;.05). Conclusion: With low downgrade rates and high diagnosis accuracy, the current HEMS triage process, although not consistently documented, accurately detects stroke, even for low acuity cases. Patients arriving via HEMS receive equal access to stroke treatment with significantly faster treatment times, ensuring the best possible prognosis. EMS educational efforts should focus on improving documentation compliance.

A study of factors associated with the prognosis of cardiac arrest patients in a depopulated area with a high elderly population transported by Shimoda Fire Department.

Objective: To investigate the etiology of cardiac arrest in patients living in depopulated rural areas with a high elderly population in the Kamo region. Patients and Methods: We investigated patients with cardiac arrest who were transported by the Shimoda Fire Department between January 2019 and December 2021. The following patients' details were collected: circumstance, age, sex, cause of cardiac arrest, witnessed collapse, chest compression performed by bystanders, oral instruction, use of an automated external defibrillator (AED), initial rhythm, advanced cardiac life support provided by emergency medical technicians, and neurological outcomes. The patients were divided into two groups based on the return of consciousness (RC). We compared the variables above between the two groups. Results: A total of 281 patients with cardiac arrest were included in this study. The participants were predominantly men (59.7%), and the average age was 76 years. AED was applied to eight patients at the scene; however, all eight did not have an initial shockable rhythm. RC was achieved in eight (2.8%) patients. The precise cause of cardiac arrest among the participants who achieved RC was cardiogenic, drowning, and suffocation in three, three, and two cases, respectively. The patients were significantly younger, and the ratio of securing a venous route and airway was significantly lower in the RC (+) group than in the RC (-) group. The ratio of helicopter emergency medical services (HEMS) in the RC (+) group was significantly greater than that in the RC (-) group. Conclusion: This study reported the etiology of cardiac arrest in patients living in a depopulated rural area of Japan with a high elderly population. The usefulness of an AED could not be proven; the cardiogenic cardiac arrest was not dominant among patients who achieved RC, and HEMS transport might be useful for obtaining RC.

Comparison of Helicopter and Ground Transportation in Pediatric Trauma Patients

INTRODUCTION: Geographic and population diversity remains an issue in appropriate triage of helicopter emergency medical services (HEMS). Longer transport times in ground emergency medical services and HEMS are well-known to be associated with increased mortality. The over-triage of minor injuries to HEMS transport raises issues of cost-effectiveness. We hypothesize that HEMS transport is associated with decreased mortality and increased likelihood of discharge home without need for medical services. METHODS: This was a retrospective study of pediatric (younger than 18 years) trauma patients transported by HEMS or ground emergency medical services that were reported to the National Trauma Data Bank from 2007 to 2015. In-hospital mortality was the primary outcome, and discharge without the need for medical services was the secondary outcomes. Logistic regression models were used with and without propensity matching for demographic and injury-specific factors. RESULTS: There were 348,107 patients identified from the National Trauma Data Bank. After propensity matching, 21.9% of ground emergency medical services cases and 96.0% of HEMS cases were analyzed (Figure). Multivariate regression analysis showed lower odds of mortality in the HEMS group (odds ratio 0.69 [95% CI 0.64 to 0.75], p < 0.01) and increased odds of discharge home without services (odds ratio 1.29 [95% CI 1.22 to 1.41], p < 0.01).Figure.: EMS, emergency medical services; GEMS, ground medical emergency services; HEMS, helicopter emergency medical services.CONCLUSION: Appropriate triage remains an important clinical issue requiring ongoing investigation. We showed that pediatric patients transported by HEMS had decreased odds of mortality and increased odds of discharge home without services. Further research is needed to identify specific factors that may influence these results such as access to home services, insurance status, transport times, and indications for HEMS transport.

Transport of the patient with trauma: a narrative review.

Trauma and injury place a significant burden on healthcare systems. In most high-income countries, well-developed acute pre-hospital and trauma care systems have been established. In Europe, mobile physician-staffed medical teams are available for the most severely injured patients and apply a wide variety of lifesaving interventions at the same time as ensuring patient comfort. In trauma systems providing pre-hospital care, medical interventions are performed earlier in the patient journey and do not affect time to definite care. The mode of transport from the accident scene depends on the organisation of the healthcare system and the level of hospital care to which the patient is transported. This varies from 'scoop and run' to a basic community care setting, to advanced helicopter emergency medical service transport to a level 4 trauma centre. Secondary transport of trauma patients to a higher level of care should be avoided and may lead to a delay in definitive care. Critically injured patients must be accompanied by at least two healthcare professionals, one of whom must be skilled in cardiopulmonary resuscitation and advanced airway management techniques. Ideally, the standard of care provided during transport, including the level of monitoring, should mirror hospital care. Pre-hospital care focuses on the critical care patient, but the majority of injured patients need only close observation and pain management during transport. Providing comfort and preventing additional injury is the responsibility of the whole transport team.

Overutilization of Helicopter Emergency Medical Services in Central Gulf Coast Region Results in Unnecessary Expenditure.

When appropriately used, helicopter emergency medical services (HEMSs) allow for timely delivery of severely injured patients to definitive care. Inappropriate utilization of HEMSs results in increased cost to the patient and trauma system. The purpose of this study was to review current HEMS criteria in the central Gulf Coast region and evaluate for potential areas of triage refinement and cost savings. We hypothesized that a significant number of patients received potentially unwarranted HEMS transport. A retrospective cohort study of all patients with trauma arriving to a level I trauma center by helicopter over 28mo was performed; 381 patients with trauma and with HEMS transport from the scene were included. Data were collected from prehospital sources, as well as hospital chart review for each patient. The primary outcome was the rate of unwarranted HEMS transport. A total of 381 adult patients with trauma transported by the HEMS were analyzed, of which 34% were deemed potentially nonwarranted transports. The significant factors correlating with warranted HEMS transport included age, multiple long bone fractures, penetrating mechanism, and vehicle ejection. Insurance demographics did not correlate to transport modality. Many of these patients were transported from a location within the same county or the county adjacent to the trauma center. When comparing patients transported by ground and HEMSs from the same scene, no time savings were identified. Unwarranted transports at the trauma center represented an estimated health care expenditure of over $3 million. HEMSs may be overused in the central Gulf Coast region, creating the risk for a substantial resource and financial burden to the trauma system. Further collaboration is needed to establish HEMS triage criteria, that is, more appropriate use of resources.

Effect of time intervals in critical care provided by helicopter emergency medical services on 30-day survival after trauma

BackgroundTrauma is the leading cause of death especially in children and young adults. Prehospital care following trauma emphasizes swift transport to a hospital following initial care. Previous studies have shown conflicting results regarding the effect of time on the survival following major trauma. In our study we investigated the effect of prehospital time-intervals on 30-day mortality on trauma patients that received prehospital critical care. MethodsWe performed a retrospective study on all trauma patients encountered by helicopter emergency medical services in Finland from 2012 to 2018. Patients discharge diagnoses were classed into (1) trauma without traumatic brain injury, (2) isolated traumatic brain injury and (3) trauma with traumatic brain injury. Emergency medical services response time, helicopter emergency medical services response time, on-scene time and transport time were used as time-intervals and age, Glasgow coma scale, hypotension, need for prehospital airway intervention and ICD-10 based Injury Severity Score were used as variables in logistic regression analysis. ResultsMortality data was available for 4,803 trauma cases. The combined 30-day mortality was 12.1% (582/4,803). Patients with trauma without a traumatic brain injury had the lowest mortality, at 4.3% (111/2,605), whereas isolated traumatic brain injury had the highest, at 22.9% (435/1,903). Patients with both trauma and a traumatic brain injury had a mortality of 12.2% (36/295). Following adjustments, no association was observed between time intervals and 30-day mortality. DiscussionOur study revealed no significant association between different timespans and mortality following severe trauma in general. Trends in odds ratios can be interpreted to favor more expedited care, however, no statistical significance was observed. As trauma forms a heterogenous patient group, specific subgroups might require different approaches regarding the prehospital timeframes. Study typeprognostic/therapeutic/diagnostic test.

Helicopter Emergency Medical Services Transport of COVID-19 Patients in the “First Wave”: A National Survey

Study objectivesHelicopter emergency medical services (HEMS) providers have had to adjust to transporting patients with a novel, highly infectious pathogen. This study describes how HEMS organizations in the USA approached the coronavirus disease 2019 (COVID-19) pandemic in its first wave.MethodsA survey was distributed via REDCap™ to HEMS organizations in May of 2020 using a national database. Data were collected regarding agency demographics and COVID-19 practices, including education, risk assessment, protective measures, equipment use, and decontamination practices. These were analyzed for qualitative observations and program attributes for COVID transport.ResultsA total of 68/287 (24%) organizations responded and completed the survey. Eighty-five percent (85%) of responding programs reported that they chose to transport known or suspected COVID-19 patients by air medical transport. Of responding programs, 93% provided education to their providers regarding COVID-19 and 100% conducted a COVID-19 risk analysis for patient transports. Of agencies transporting known or suspected COVID-19 patients, 77% required the use of N95 filtering facepiece respirators (N95) or powered air-purifying respirators (PAPR) for crewmembers during known or suspected COVID-19 patient transfers and 95% provided N95 respirators for pilots during transport. Five percent of responding programs utilized portable negative pressure isolation units. For COVID-19 transporting and non-transporting agencies, when transporting non-COVID-19 known or suspected patients, personal protective equipment (PPE) practice varied but tended to be more relaxed. Some services separated pilots from providers even during downtime (29%). Among services transporting known or suspected COVID-19 patients, the most common decontamination practice was manual wipe-down of all surfaces for a downtime of less than two hours.ConclusionThe majority of survey respondents report that their programs chose to transport patients with known or suspected COVID-19 by air medical transport. However, there was high variability in practices regarding the transport of known or suspected COVID-19 as well as that of non-COVID-19 known or suspected patients by air during the initial outbreak of the pandemic. The HEMS industry may benefit from further research and standardization of airborne highly infectious disease transport practices in preparation for the next respiratory virus pandemic.

Endotracheal Tube Intracuff Pressure Changes in Patients Transported by a Helicopter Emergency Medical Service: A Prospective Observational Study

ObjectiveThe pressure within an endotracheal tube cuff is of particular importance in helicopter emergency medical services (HEMS) transport because the unpressurized cabin is subjected to decreases in atmospheric pressure. This can cause the cuff to overinflate and may be associated with clinical complications. We sought to evaluate endotracheal tube cuff pressure changes among intubated patients during HEMS transport. MethodsA prospective observational study was performed including adult patients who were intubated and transported by helicopter between April 2017 and October 2018. Cuff pressures were measured before, during, and after HEMS transport with a commercial manometer. ResultsA total of 208 patients were included. The median maximum flight altitude was 3,000 (interquartile range [IQR], 2,000-5,000) ft. The median initial cuff pressure before takeoff was 35 (IQR, 24-50) cm H2O, which increased to 50 (IQR, 35-70) cm H2O at maximum altitude. A total of 169 (81.3%) patients had a cuff pressure > 30 cm H2O at maximum altitude. There was a moderate correlation between altitude and cuff pressure (r = 0.532, P < .001). ConclusionsCuff pressure increased during HEMS transport, demonstrating the need for routine cuff pressure monitoring during flight. Further research is required to determine if exposure to transient increases in cuff pressure for short durations is clinically significant.

Helicopter Transportation of Brazilian Trauma Patients: A Comparison of Times to Care

ObjectiveThe purpose of this study was to analyze helicopter emergency medical service (HEMS) transport with secondary land ambulance transfer, comparing landings performed inside and outside the hospital complex to the emergency department. MethodsThis was a cross-sectional observational study of HEMS transports of trauma patients between 2016 and 2018 in southern Brazil. Patients were attended by the HEMS team at the trauma site or stabilized in hospitals nearby and subsequently referred to trauma centers. In this region, no trauma centers have their own helipads so helicopters land in remote areas close to the hospital, which may be inside or outside the hospital complex. Both landings require ground emergency medical service transport, with off-site landings necessitating ground emergency medical service transport via public access roads to reach the hospital. Data were analyzed using descriptive statistics, and on-site and off-site transport times were compared using a t-test for independent samples. ResultsOf 176 transports, 28.5% resulted in on-site landings, whereas 71.5% occurred off-site. The ground transport time when the landing zone was off-site was 5 minutes longer than on-site (P < .001). ConclusionOff-site landings result in longer transports to the emergency room. The construction of helipads in trauma centers can reduce transport time, in addition to reducing the costs and sequelae of trauma.

Helicopter Emergency Medical Service and Hospital Treatment Levels Affect Survival in Pediatric Trauma Patients.

(1) Background: Data on the effects of helicopter emergency medical service (HEMS) transport and treatment on the survival of severely injured pediatric patients in high-level trauma centers remain unclear. (2) Methods: A national dataset from the TraumaRegister DGU® was used to retrospectively compare the mortality rates among severely injured pediatric patients (1–15 years) who were transported by HEMS to those transported by ground emergency medical service (GEMS) and treated at trauma centers of different treatment levels (levels I–III). (3) Results: In total, 2755 pediatric trauma patients (age: 9.0 ± 4.8 years) were included in this study over five years. Transportation by HEMS resulted in a significant survival benefit compared to GEMS (odds ratio (OR) 0.489; 95% confidence interval (CI): 0.282–0.850). Pediatric trauma patients treated in level II or III trauma centers showed 34% and fourfold higher in-hospital mortality risk than those in level I trauma centers (level II: OR 1.34, 95% CI: 0.70–2.56; level III: OR 4.63, 95% CI: 1.33–16.09). (4) Conclusions: In our national pediatric trauma cohort, both HEMS transportation and treatment in level I trauma centers were independent factors of improved survival in pediatric trauma patients.

Use of Helicopter Emergency Medical Services in the Transport of Patients With Known or Suspected Coronavirus Disease 2019

ObjectiveLimited information exists regarding the response of helicopter emergency medical services (HEMS) programs to patients with known or suspected coronavirus disease 2019 (COVID-19). The purpose of this study was to determine changes in flight operations during the early stages of the pandemic. MethodsA survey of the American College of Emergency Physicians Air Medical Section was conducted between May 13, 2020, and August 1, 2020. COVID-19 prevalence was defined as high versus low based on cases > 2,500 or ≤ 2,500. ResultsOf the 48 respondents, the majority (89.6%) reported that their patient guidelines had changed because of COVID-19; 89.6% of programs reported transporting COVID-19–positive patients, whereas 91.5% reported transporting persons under investigation. The majority of respondents reported additional training in COVID-19 airway management (79.2%) and personal protective equipment use (93.6%). Permitted aerosol-generating procedures included bilevel positive airway pressure (40.4%) and high-flow nasal oxygen (66.0%). No difference in guideline changes, positive COVID-19/persons under investigation transport restrictions, or permitted aerosol-generating procedures were noted between high- and low-prevalence settings. ConclusionCOVID-19 has resulted in changes to HEMS guidelines regardless of local disease prevalence. The pandemic has persisted sufficiently long that data regarding the effectiveness of guideline changes should be analyzed. In the absence of definitive data, national best practices should be developed to guide COVID-19 HEMS transport.

Determining a Need for Point-of-Care Ultrasound in Helicopter Emergency Medical Services Transport

ObjectivePoint-of care-ultrasound (PoCUS) is useful in evaluating unstable emergency department patients. The portability of this technology increases its potential use in prehospital settings, including helicopter emergency medical services (HEMS) programs. Identifying useful applications may support implementing a PoCUS program that develops sonography skills for prehospital providers. The aim of this study was to determine the HEMS patient population that would benefit from prehospital PoCUS for hypotension and how commonly the extended focused assessment with sonography in trauma (E-FAST) for trauma patients or the rapid ultrasound in shock (RUSH) for medical patients could be used by HEMS. MethodsA retrospective chart review was performed over a 1-year period of adult patients transported by a midwestern HEMS system. Charts were reviewed for episodes of hypotension. ResultsThe chart review included 216 charts, of which 3 were excluded. Of the 213 cases, 100 were trauma patients, and 113 were medical patients. Of the trauma patients, 51% experienced hypotension, as did 73 of 113 medical patients. ConclusionFifty percent of HEMS patients may benefit from PoCUS to evaluate for hypotension in flight.

Acute Risk in Helicopter EmergencyMedical Service Transport Operations

Objective: The highest safety risk for helicopter emergency medical service (HEMS) operations in the United States is during night-time operations. Although guidelines recommend physicians consider the risk to the patient and flight crew when triaging a patient for flight, no objective measure of risk between day and night-time HEMS flights exist. The purpose of this study was to measure the acute risk of HEMS transport within a spectrum of aviation and medical procedure risk. Methods: The number of fatal HEMS accidents, fatal patient injuries and patients transported by day and night between 1995 to 2015 were classified as events and measure of activities, respectively. Acute risk was measured using the MicroMort (mM) which represents a one in a million chance of dying from an accident. Comparisons with other activities were used to contextualize aviation and medical procedure risk. Results: Each daytime HEMS task (7.55 mM) was similar to one parachute jump (7.96 mM). One night-time HEMS task in hazardous operational conditions (18.75 mM) was over ten-times greater than one scuba dive (1.84 mM). Patient night-time mortality (6.43 mM) was similar to one general anaesthetic (8.2 mM). Conclusion: Daytime HEMS accident risk is of similar risk to one parachute jump, and at night-time in hazardous operational conditions over ten-times greater than one scuba dive. Where a patient’s risk of death from their injury or illness is not greater than that of a general anaesthetic, triage for a night HEMS transport may introduce greater risk than the patient’s medical condition itself.

Association Between Mode of Transportation and Outcomes in Penetrating Trauma Across Different Prehospital Time Intervals: A Matched Cohort Study.

National guidelines do not provide recommendations concerning optimal dispatch time for helicopter emergency medical services (HEMS) in the United States. This study describes the association between mode of transport (ground vs. helicopter) and survival of patients with penetrating injury across different prehospital time intervals and proposes evidence-based time-related dispatch criteria for HEMS. A retrospective matched cohort study was conducted using the 2015 National Trauma Data Bank. Adult patients (age≥16years) with penetrating injuries were included. Patients transported via HEMS were selected and matched (1 to 1) for 17 variables to patients transported by ground ambulance (GEMS). Bivariate analyses were conducted to compare characteristics and outcomes (survival to hospital discharge) of patients across different prehospital time intervals. Each group consisted of 949 patients. Overall survival rate was similar in both groups (90.6% for HEMS vs. 87.9% for GEMS, p=0.054). Patients transported by HEMS had significantly higher survival compared with those transported by GEMS (92.5% for HEMS vs. 87.0% for GEMS, p=0.002) in the 0-60-min time interval from dispatch to arrival to hospital, and more specifically, in the 31-60-min interval (92.2% vs. 85.2%, p=0.001). No difference in survival between the two groups was observed in the shortest (0-30min) or in the extended prehospital time intervals (>60min). In adult patients with penetrating trauma, HEMS transport was associated with improved survival in a specific total prehospital time interval (31 to 60min). This finding can help emergency medicine service administrators develop evidence-based HEMS dispatch criteria.

The utility of physician-staffed helicopters for managing individuals who experience severe isolated head trauma.

Objective: The authors retrospectively investigated prognostic factors for severe isolated head trauma in patients evacuated by a physician-staffed helicopter emergency medical service (HEMS) or ground ambulance using data from the Japan Trauma Data Bank (JTDB).Patients and Methods: This study was a retrospective analysis of data housed in the JTDB database. The study period was from January 2004 to May 2019. Subjects were divided into two groups according to the method of transportation: helicopter (i.e., HEMS), which included patients transported by a physician-staffed helicopter; and ambulance, which included patients transported by ground ambulance.Results: A total of 41,358 patients were enrolled in the study, including 2,029 in the helicopter group and 39,329 in the ambulance group. The ratio of males, median head Abbreviated Injury Scale and Injury Severity Scale (ISS) scores were significantly greater in the helicopter group than in the ambulance group, while the average age, median Glasgow Coma Scale, average Revised Trauma Score (RTS), and survival rate were significantly lower in the helicopter group than in the ambulance group. Of the variables that demonstrated statistical significance in the univariate analysis and classification of transportation and included in the multivariate analysis, the following were identified as significant predictors of survival outcomes: younger age, lower ISS, female sex, and greater RTS. HEMS was not a significant predictor of survival.Conclusion: The present study revealed no effect of HEMS transport on the outcomes of patients who experienced severe isolated head trauma compared with ground ambulance transportation. Further prospective studies, including an analysis of the operation time or distance traveled by the HEMS and the functional outcome(s) of patients with severe head injury transported by HEMS, are warranted.

Mechanical ventilation of patients in helicopter emergency medical service transport: an international survey

BackgroundMechanical ventilation in helicopter emergency medical service (HEMS) environments is a procedure which carries a significant risk of complications. Limited data on the quality and performance of mechanical ventilation in HEMS are available in the literature.MethodWe conducted an international survey to evaluate mechanical ventilation infrastructure in HEMS and collect data of transported ventilated patients. From June 20–22, 2019, the participating HEMS bases were asked to provide data via a web-based platform. Vital parameters and ventilation settings of the patients at first patient contact and at handover were compared using non-parametric statistical tests.ResultsOut of 215 invited HEMS bases, 53 responded. Respondents were from Germany, Denmark, United Kingdom, Luxembourg, Austria and Switzerland. Of the HEMS bases, all teams were physician staffed, mainly anesthesiologists (79%), the majority were board certified (92.5%) and trained in intensive care medicine (89%) and had a median (range) experience in HEMS of 9 (0–25) years. HEMS may provide a high level of expertise in mechanical ventilation whereas the majority of ventilators are able to provide pressure controlled ventilation and continuous positive airway pressure modes (77%). Data of 30 ventilated patients with a median (range) age of 54 (21–100) years and 53% male gender were analyzed. Of these, 24 were primary missions and 6 interfacility transports. At handover, oxygen saturation (p < 0.01) and positive end-expiratory pressure (p = 0.04) of the patients were significantly higher compared to first patient contact.ConclusionIn this survey, the management of ventilated HEMS-patients was not associated with ventilation related serious adverse events. Patient conditions, training of medical crew and different technical and environmental resources are likely to influence management. Further studies are necessary to assess safety and process quality of mechanical ventilation in HEMS.Trial registrationThe survey was prospectively registered at Research Registry (researchregistry2925).