Helicopter emergency medical services in major incident management: A national Norwegian cross-sectional survey.

OBJECTIVE: Helicopter Emergency Medical Services (HEMS) aim to bring a highly specialised crew to the scene of major incidents for triage, treatment and transport. We aim to describe experiences made by HEMS in Norway in the management of major incidents. DESIGN: Doctors, rescue paramedics and pilots working in Norwegian HEMS and Search and Rescue Helicopters (SAR) January 1st 2015 were invited to a cross-sectional study on experiences, preparedness and training in major incident management. RESULTS: We identified a total of 329 Norwegian crewmembers of which 229 (70%) responded; doctors 101/150, (67%), rescue paramedics 64/78 (82%), pilots 64/101, (63%). HEMS and SAR crewmembers had experience from a median of 2 (interquartile range 0-6) major incidents. Road traffic incidents were the most frequent mechanism and blunt trauma the dominating injury. HEMS mainly contributed with triage, treatment and transport. Communication with other emergency services prior to arrival was described as bad, but good to excellent when cooperating on scene. The respondents called for more interdisciplinary exercises. CONCLUSION: HEMS and SAR crewmembers have limited exposure to major incident management. Interdisciplinary training on frequent scenarios with focus on cooperation and communication is called for.

Reporting Helicopter Emergency Medical Services in Major Incidents: A Delphi Study.

OBJECTIVE: Research on helicopter emergency medical services (HEMS) in major incidents is predominately based on case descriptions reported in a heterogeneous fashion. Uniform data reported with a consensus-based template could facilitate the collection, analysis, and exchange of experiences. This type of database presently exists for major incident reporting at www.majorincidentreporting.net. This study aimed to develop a HEMS-specific major incident template. METHODS: This Delphi study included 17 prehospital critical care physicians with current or previous HEMS experience. All participants interacted through e-mail. We asked these experts to define data variables and rank which were most important to report during an immediate prehospital medical response to a major incident. Five rounds were conducted. RESULTS: In the first round, the experts suggested 98 variables. After 5 rounds, 21 variables were determined by consensus. These variables were formatted in a template with 4 main categories: HEMS background information, the major incident characteristics relevant to HEMS, the HEMS response to the major incident, and the key lessons learned. CONCLUSION: Based on opinions from European experts, we established a consensus-based template for reporting on HEMS responses to major incidents. This template will facilitate uniformity in the collection, analysis, and exchange of experience.

Utilisation of helicopter emergency medical services in the early medical response to major incidents: a systematic literature review.

OBJECTIVE: This systematic review identifies, describes and appraises the literature describing the utilisation of helicopter emergency medical services (HEMS) in the early medical response to major incidents. SETTING: Early prehospital phase of a major incident. DESIGN: Systematic literature review performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, the Web of Science, PsycINFO, Scopus, Cinahl, Bibsys Ask, Norart, Svemed and UpToDate were searched using phrases that combined HEMS and 'major incidents' to identify when and how HEMS was utilised. The identified studies were subjected to data extraction and appraisal. RESULTS: The database search identified 4948 articles. Based on the title and abstract, the full text of 96 articles was obtained; of these, 37 articles were included in the review, and an additional five were identified by searching the reference lists of the 37 articles. HEMS was used to transport medical and rescue personnel to the incident and to transport patients to the hospital, especially when the infrastructure was damaged. Insufficient air traffic control, weather conditions, inadequate landing sites and failing communication were described as challenging in some incidents. CONCLUSIONS: HEMS was used mainly for patient treatment and to transport patients, personnel and equipment in the early medical management of major incidents, but the optimal utilisation of this specialised resource remains unclear. This review identified operational areas with improvement potential. A lack of systematic indexing, heterogeneous data reporting and weak methodological design, complicated the identification and comparison of incidents, and more systematic reporting is needed. TRIAL REGISTRATION NUMBER: CRD42013004473.

Rapid extrication of entrapped victims in motor vehicle wreckage using a Norwegian chain method - cross-sectional and feasibility study.

BACKGROUND: Road traffic injury (RTI) is a global problem causing some 1,2 million deaths annually and another 20-50 million people sustain non-fatal injuries. Pre-hospital entrapment is a risk factor for complications and delays transport to the hospital. The Rapid Extrication (RE) method combines winching and cutting of both front poles and utilising two larger vehicles to pull car wreckage apart to extricate patients. A previous study indicates that RE is an efficient alternative to previously existing methods. METHODS: All Fire Departments in Norway were questioned on: background, frequency of training, use and implementation of the method, protocol and equipment. Times used for extrication from motor vehicle wreckage were measured at the National Championship in RE. Questionnaires presented to participants asked about frequency of training, inter-disciplinary cooperation and self-perceived safety for both providers and patients on a 1-7 Likert scale (1 - worst and 7 - best). RESULTS: Participating Fire Departments use RE in 95% of cases on passenger cars and 77% of cases on larger vehicles. Teams participating in the National Championship scored self-perceived security of crew as median 7 and IQR (6, 7), patient safety 7 (6, 7), communication between personnel 7 (6, 7), teamwork 7 (6, 7), and how well the technique functioned 7 (6, 7).All teams had extricated and transported the patient into the ambulance within 20 minutes. CONCLUSION: Interdisciplinary and regular training of RE can lead to safe extrication of a critically injured patient in less than 20 minutes and may be life saving.

Impact of helicopter emergency medical services in major incidents: systematic literature review.

INTRODUCTION: Helicopter emergency medical services (HEMS) aim to bring highly specialised crews to the major incident for triage, treatment and transport. When the site is difficult to access, HEMS may be the only mode of transportation of both personnel and patients. This systematic review will identify, describe and appraise literature regarding the role of HEMS in medical response to major incidents. We aim to improve knowledge on HEMS role in a major incident and provide a basis for future research. METHODS AND ANALYSIS: A systematic literature review will be conducted with search phrases that combine HEMS and major incidents to identify when and how HEMS have been used. Included literature will be subject to quality appraisal and data extraction. ETHICS: No ethical approval is sought because this is a literature review. It will be submitted to a peer-reviewed journal and the PRISMA guidelines will be followed. REGISTRATION DETAILS: PROSPERO CRD42013004473.