Helicopter Emergency Medical Systems Research Articles

Analgesia in pediatric trauma patients in physician-staffed Austrian helicopter rescue: a 12-year registry analysis

BackgroundAs pediatric patients are typically rare among helicopter emergency medical systems (HEMS), children might be at risk for oligo-analgesia due to the rescuer’s lack of experience and the fear of side effects.MethodsIn this retrospective analysis, data was obtained from the ÖAMTC HEMS digital database including 14 physician staffed helicopter bases in Austria over a 12-year timeframe. Primary missions involving pediatric trauma patients (< 15 years) not mechanically ventilated on-site were included. Analgesia was assessed and compared between the age groups 0–5, 6–10 and 11–14 years.ResultsOf all flight missions, 8.2% were dedicated to children < 15 years. Analgetic drugs were administered in 31.4% of all primary missions (3874 of 12,324), wherefrom 2885 were injured and non-ventilated (0–5 yrs.: n = 443; 6–10 yrs.: n = 902; 11–14 yrs.: n = 1540). The majority of these patients (> 75%) suffered moderate to severe pain, justifying immediate analgesia. HEMS physicians typically chose a monotherapy with an opioid (n = 1277; 44.3%) or Esketamine (n = 1187; 41.1%) followed by the combination of both (n = 324; 11.2%). Opioid use increased (37.2% to 63.4%) and Esketamine use decreased (66.1% to 48.3%) in children < 6 vs. > 10 years. Esketamine was more often administered in extremity (57.3%) than in head (41.5%) or spine injuries (32.3%). An intravenous access was less often established in children < 6 years (74.3% vs. 90.8%; p < 0.001). Despite the use of potent analgesics, 396 missions (13.7%) were performed without technical monitoring. Particularly regarding patient data at handover in hospital, merely < 10% of all missions featured complete documentation. Therefore, sufficient evaluation of the efficacy of pain relief was not possible. Yet, by means of respiratory measures required during transport, severe side effects such as respiratory insufficiency, were barely noted.ConclusionsIn the physician-staffed HEMS setting, pediatric trauma patients liberally receive opioids and Esketamine for analgesia. With regard to severe respiratory insufficiency during transport, the application of these potent analgesics seems safe.

Mechanical chest compression devices in the helicopter emergency medical service in Switzerland

BackgroundOver the past years, several emergency medical service providers have introduced mechanical chest compression devices (MCDs) in their protocols for cardiopulmonary resuscitation (CPR). Especially in helicopter emergency medical systems (HEMS), which have limitations regarding loading weight and space and typically operate in rural and remote areas, whether MCDs have benefits for patients is still unknown. The aim of this study was to evaluate the use of MCDs in a large Swiss HEMS system.Materials and methodsWe conducted a retrospective observational study of all HEMS missions of Swiss Air rescue Rega between January 2014 and June 2016 with the use of an MCD (Autopulse®). Details of MCD use and patient outcome are reported from the medical operation journals and the hospitals’ discharge letters.ResultsMCDs were used in 626 HEMS missions, and 590 patients (94%) could be included. 478 (81%) were primary missions and 112 (19%) were interhospital transfers. Forty-nine of the patients in primary missions were loaded under ongoing CPR with MCDs. Of the patients loaded after return of spontaneous circulation (ROSC), 20 (7%) experienced a second CA during the flight. In interhospital transfers, 102 (91%) only needed standby use of the MCD. Five (5%) patients were loaded into the helicopter with ongoing CPR. Five (5%) patients went into CA during flight and the MCD had to be activated. A shockable cardiac arrhythmia was the only factor significantly associated with better survival in resuscitation missions using MCD (OR 0.176, 95% confidence interval 0.084 to 0.372, p < 0.001).ConclusionWe conclude that equipping HEMS with MCDs may be beneficial, with non-trauma patients potentially benefitting more than trauma patients.

Brain Emergency Management Initiative for Optimizing Hub–Helicopter Emergency Medical Systems–Spoke Transfer Networks

ObjectiveEmbolectomy is standard for select occlusions up to 24 hours. Transfer patients may have worse outcomes than those originating in embolectomy centers. We developed the Brain Emergency Management Initiative (BEMI) protocol to streamline this transfer process and mimic the urgency that surrounds ST-elevation myocardial infarction cardiac evaluations. MethodsWe conducted an exploratory assessment of consecutive acute telestroke patients transferred for potential intervention in pre-BEMI versus BEMI periods. Times included spoke in, spoke out, hub in, and groin puncture. Outcomes included discharge destination and symptomatic intracranial hemorrhage. ResultsOverall, 68 transfers were assessed. There was a higher National Institute of Neurological Disorders and Stroke in BEMI (11 pre-BEMI vs. 20 B.M., P = .01). There were shorter spoke door in to door out (143 vs. 118 minutes, P = .01) and spoke door out to hub door in times (23 minutes pre-BEMI vs. 21 minutes BEMI, P = .001). For embolectomy patients, there was shorter hub door in to reperfusion (83 minutes pre-BEMI vs. 74 minutes BEMI, P = .04) and recombinant tissue plasminogen decision to groin puncture (155 minutes pre-BEMI vs. 130 minutes BEMI; P = .01). There were no symptomatic intracranial hemorrhage or discharge differences. ConclusionIn our hub–helicopter emergency medical services–spoke telestroke network, BEMI led to improved evaluation times. BEMI may serve as a model for future rapid stroke transfer pathways.

Physician staffed helicopter emergency medical systems can provide advanced trauma life support in mountainous and remote areas

IntroductionIn remote and mountainous areas, helicopter emergency medical systems (HEMS) are used to expedite evacuation and provide pre-hospital advanced trauma life support (ATLS) in major trauma victims. Aim of the study was to investigate feasibility of ATLS in HEMS mountain rescue missions and its influence on patient condition at hospital admission. Patients58 major trauma victims (Injury Severity Score ≥16), evacuated by physician staffed HEMS from remote and mountainous areas in the State of Tyrol, Austria between 1.1.2011 and 31.12.2013. ResultsPre-hospital time exceeded 90min in 24 (44%) cases. 31 (53%) patients suffered critical impairment of at least one vital function (systolic blood pressure <90mmHg, GCS <10, or respiratory rate <10 or >30). 4 (6.9%) of 58 patients died prior to hospital admission. Volume resuscitation was restrictive: 18 (72%) of 25 hypotensive patients received ≤500ml fluids and blood pressure was increased >90mmHg at hospital admission in only 9 (36%) of these 25 patients. 8 (50%) of 16 brain trauma patients with a blood pressure <90mmHg remained hypotensive at hospital admission. Endotracheal intubation was accomplished without major complications in 15 (79%) of 19 patients with a Glasgow Coma Scale score <10. Rope operations were necessary in 40 (69%) of 58 cases and ATLS was started before hoist evacuation in 30 (75%) of them. ConclusionsThe frequent combination of prolonged pre-hospital times, with critical impairment of vital functions, supports the need for early ATLS in HEMS mountain rescue missions. Pre-hospital endotracheal intubation is possible with a high success and low complication rate also in a mountain rescue scenario. Pre-hospital volume resuscitation is restrictive and hypotension is reversed at hospital admission in only one third of patients. Prolonged pre-hospital hypotension remains an unresolved problem in half of all brain trauma patients and indicates the difficulties to increase blood pressure to a desired level in a mountain rescue scenario. Despite technical considerations, on-site ATLS is feasible for an experienced emergency physician in the majority of rope rescue operations.

Risk management analysis of air ambulance blood product administration in combat operations.

Between June-October 2012, 61 flight-medic-directed transfusions took place aboard U.S. Army Medical Evacuation (medevac) helicopters in Afghanistan. This represents the initial experience for pre-hospital blood product transfusion by U.S. Army flight medics. We performed a retrospective review of clinical records, operating guidelines, after-action reviews, decision and information briefs, bimonthly medical conferences, and medevac-related medical records. A successful program was administered at 10 locations across Afghanistan. Adherence to protocol transfusion indications was 97%. There were 61 casualties who were transfused without any known instance of adverse reaction or local blood product wastage. Shock index (heart rate/systolic blood pressure) improved significantly en route, with a median shock index of 1.6 (IQR 1.2-2.0) pre-transfusion and 1.1 (IQR 1.0-1.5) post-transfusion (P < 0.0001). Blood resupply, training, and clinical procedures were standardized across each of the 10 areas of medevac operations. Potential risks of medical complications, reverse propaganda, adherence to protocol, and diversion and/or wastage of limited resources were important considerations in the development of the pilot program. Aviation-specific risk mitigation strategies were important to ensure mission success in terms of wastage prevention, standardized operations at multiple locations, and prevention of adverse clinical outcomes. Consideration of aviation risk mitigation strategies may help enable other helicopter emergency medical systems to develop remote pre-hospital transfusion capability. This pilot program provides preliminary evidence that blood product administration by medevac is safe.

Using the FIA score to predict outcome in crashes after German rescue helicopter accidents

Background: In the past decades, multiple studies have examined factors influencing occupant survival after aviation crashes, but only few have addressed this question for Helicopter Emergency Medical Systems (HEMS) accidents. The four-point FIA Score1 is a valid and established tool to measure fatality risk in aviation crashes. The aim of the present study was to analyze usefulness of the FIA Score in German HEMS accidents and to predict fatalities and survival after HEMS accidents.

Does helicopter transport impact outcome following trauma?

Helicopter transport (HT) has evolved from military roots into a critical component of trauma systems throughout the world. Concerns over cost and safety continue to challenge the role of HT in the civilian setting. Despite this, recent evidence has demonstrated a survival advantage for trauma patients undergoing HT. For patients transported from the scene of injury, improved survival has been shown in several multicenter studies as well as evaluation of large national databases. Issues of overtriage, however, remain problematic for scene HT and represent a prime area for future research in helicopter emergency medical systems (EMS). Patients undergoing inter-facility transfer have also been shown to have improved outcomes over ground transport in terms of shorter transfer times and increased survival particularly in more severely injured patients. The benefits seen are likely a result of a combination of rapid transport, advanced medical capabilities, and accessibility to remote terrain. Several subgroups of patients undergoing HT have been the subject of study as well. Patients with severe head injury have consistently been shown to have superior outcomes over ground ambulance, attributable to improvements in airway management early in the course of their injury. Conversely, HT for urban and penetrating injury has not seen similar benefits, likely due to proximity of trauma centers and recent advancements in urban EMS systems. The benefits of including physicians in helicopter crews are less clear and vary by region and system. Helicopter transport for trauma does appear to improve outcomes for trauma patients, and optimizing utilization of this valuable resource will be key as the role of helicopter EMS continues to develop within trauma systems.

Does helicopter transport improve outcomes independently of emergency medical system time?

Helicopter emergency medical systems (HEMS) have been reported to improve trauma survival. This study seeks to determine HEMS effect on survival across different subpopulations in relation to injury severity, degree of physiologic derangement, and transportation time (TT). The 2007 National Trauma Data Bank adult patients transported directly to hospitals by ground ambulance or HEMS were compared in relation to their survival with discharge and other possible confounders. Multivariate models were constructed to determine the adjusted odds ratios (OR) of survival for the entire cohort and across subpopulations stratified by different Injury Severity Score (ISS), hospital Revised Trauma Score (RTS), and TT. A total of 192,422 patients with complete data were analyzed. HEMS patients (15.3%) experienced lower survival rates than those transported by ground (93.8% vs. 96.1%, p < 0.001). Multivariate analysis revealed a survival advantage for HEMS in the entire cohort (OR, 1.78 [1.65-1.92]). Adding TT to the model did not affect HEMS effect on survival. HEMS effect was present across all ISS levels but was limited to those with RTS of less than 6 (n = 15,427; OR, 2.28 [2.10-2.49]). In contrast, those with RTS of 6 or greater experienced lower adjusted survival when transported by HEMS (n = 176,995; OR, 0.83 [0.74-0.94]). Stratification by RTS and ISS did not affect the results. Substratification by TT revealed no effect of HEMS on survival among patients with RTS of less than 6, ISS of less than 16, and TT of 60 minutes or greater. Remaining associations were not affected by TT substratification. HEMS beneficial effect on survival seems to be limited to patients with physiologic instability. Physiologically stable patients seem to have a worse outcome when transported by air. Epidemiologic/prognostic study, level III.

Application of the FIA Score to German Rescue Helicopter Accidents to Predict Fatalities in Helicopter Emergency Medical Systems (HEMS) Crashes

BackgroundIn the past several decades, multiple studies have examined factors influencing occupant survival in aviation crashes, but only a few have addressed this question in Helicopter Emergency Medical Systems (HEMS) accidents. The four-point FIA Score is a valid tool to measure fatality risk in aviation crashes. ObjectiveThe aim of the present study was to analyze the performance of the FIA Score when applied to German HEMS accidents, and to determine the prognostic value for fatalities and for survival. MethodsThe FIA Score uses three parameters (F=fire; I=Instrument meteorological conditions; A=Away from airport) to determine the fatality risk after crashes. Data for German HEMS accidents between October 1970 and December 2009 were gathered retrospectively from the Federal Agency for Flight Accident Investigation. Accidents were graded according to the FIA Score by two emergency physician-pilots, and crash fatality rates (CFR) were calculated. ResultsA total of 99 HEMS accidents were analyzed that occurred from September 1970 to December 2009. In 19.2% of these, at least one occupant was fatally injured. There were 63 accidents (63.6%) that took place with no injuries; 8 occurred with minor injuries (8.1%); and 9 resulted in major injuries (9.1%). A total of 72 data sets were complete and were used for analysis. Depending on the FIA Score (FIA0, FIA1, FIA2, and FIA3), CFRs of 0.0%, 8.1%, 53.3%, and 100.0%, respectively, were calculated. ConclusionsThe FIA Score is a valuable tool in German HEMS accident analysis. It can predict fatalities and is easy to use. Thus, it may also be a valuable tool in EMS call centers to predict survival after a crash.

Medical Standards for Mountain Rescue Operations Using Helicopters: Official Consensus Recommendations of the International Commission for Mountain Emergency Medicine (ICAR MEDCOM)

The purpose of this article is to establish medical recommendations for safe and effective Helicopter Emergency Medical Systems (HEMS) in countries with a dedicated mountain rescue service. A nonsystematic search was undertaken and a consensus among members of International Commission for Mountain Emergency Medicine (ICAR Medcom) was reached. For the severely injured or ill patient, survival depends on approach time and quality of medical treatment by high-level providers. Helicopters can provide significant shortening of the times involved in mountain rescue. Safety is of utmost importance and everything possible should be done to minimize risk. Even in the mountainous environment, the patient should be reached as quickly as possible (optimally<20 min) and provided with on-site and en-route medical treatment according to international standards. The HEMS unit should be integrated into the Emergency Medical System of the region. All dispatchers should be aware of the specific problems encountered in mountainous areas. The nearest qualified HEMS team to the incident site, regardless of administrative boundaries, should be dispatched. The 'air rescue optimal crew' concept with its flexibility and adaptability of crewmembers ensures that all HEMS tasks can be performed. The helicopter and all equipment should be appropriate for the conditions and specific for mountain related emergencies. These recommendations, agreed by ICAR Medcom, establish recommendations for safe and effective HEMS in mountain rescue.

Intermountain Life Flight Preflight Risk Assessment Score and Transport Outcomes

Purpose In 2005, the Federal Aviation Administration recommended helicopter emergency medical systems implement a pre-flight risk assessment score (PRAS) to help pilots assess flight risks. To date, there are no studies evaluating the PRAS. This study examined the transport outcome (successful, aborted or turned-down) associated with our PRAS. Methods PRASs from August 2005 through April 2008 were retrospectively analyzed. Before each flight, pilots filled out a PRAS if the total calculated score was ≥ 15 or the flight was aborted or turned down for weather. PRASs were described in unsuccessful outcomes (aborted vs. turned down). Results 4844 of 4986 (97%) transports had PRAS < 15 with 142 PRASs (3%) being reported. Twenty-nine reports were excluded because the transport was “cancelled en route” (3), the recalculated PRAS was < 15 (21), or the PRAS was reported as a weather-related successful flight (5). Of the 113 PRASs reported, all 28 non-weather-related PRAS ≥ 15 transports were successful. Weather-related PRASs appear to be similar for aborted (20) vs. turned-down (65) flights. Conclusion Transport success rates for our PRASs < 15 (97%) and non-weather-related PRASs ≥ 15 (100%) are high. Weather-related aborted vs. turned-down PRASs have wide variability and show a high percentage (41%) of PRASs < 15.

206: Ten Years of Helicopter Emergency Medical System In Switzerland 1999 - 2008

206: Ten Years of Helicopter Emergency Medical System In Switzerland 1999 - 2008

Needs assessment for a Universal Ground Safety and Landing Zone Coordination Course for helicopter emergency medical systems

Needs assessment for a Universal Ground Safety and Landing Zone Coordination Course for helicopter emergency medical systems

Feasibility of Implementing Helicopter Emergency Medical Systems — Example from Egypt

Feasibility of Implementing Helicopter Emergency Medical Systems — Example from Egypt

Norwegian Air Ambulance: A Concept for Integrated Helicopter Emergency Medical Systems (HEMS)

Norwegian Air Ambulance: A Concept for Integrated Helicopter Emergency Medical Systems (HEMS)