The creation, implementation, and harmonisation of medical standard operating procedures and checklists of Finnish Helicopter Emergency Medical Service units.

INTRODUCTION: The purpose of this study was to investigate the creation, implementation, and harmonisation of medical Standard Operating Procedures (SOP) in Finnish Helicopter Emergency Medical Services (HEMS). The research questions are: (1) What factors influence the creation and implementation of medical SOPs for Finnish HEMS units? and (2) What can be done to harmonise the medical SOPs of Finnish HEMS units? METHODS: The research was conducted as a qualitative interview study with HEMS physicians who worked full-time in Finnish HEMS units or had worked in HEMS for more than five years. Three HEMS physicians from each of the six HEMS units in Finland participated in the study (n = 18). The thematic interviews (average duration 32 min) were transcribed (70,176 words in Finnish) and analysed using inductive content analysis. RESULTS: The results of the first research question formed three main categories: (1) Background to developing medical SOPs and checklists (CLs), (2) Creation of medical SOPs in Finnish HEMS units, and (3) Implementation of medical SOPs and CLs. The main categories were divided into eight upper categories and twelve subcategories. The results of the second research question formed four main categories: (1) Prerequisites for harmonising procedures, (2) System-level changes needed, (3) Integrating common medical SOPs into HEMS, and (4) Cultural change. The main categories were divided into nine upper categories and nine subcategories. CONCLUSIONS: Medical SOPs and CLs are an integral part of Finnish HEMS. Each unit creates its own SOPs and CLs; their development, implementation, and follow-up are relatively unstructured. Harmonising existing SOPs would be possible, but developing common SOPs would require structural changes in HEMS and a stronger sense of community belonging among HEMS physicians.

Impact of icing weather conditions on the patients in helicopter emergency medical service: a prospective study from Northern Finland.

BACKGROUND: A high number of denied or cancelled HEMS missions are caused by poor weather conditions especially during winter season. Furthermore, many helicopter manufacturers have denied their helicopters to be operated in known icing conditions. Icing is a widely known phenomenon in aviation, but there is a lack of evidence about its influence on HEMS operations and patients. METHODS: A prospective observational study of HEMS missions in Northern Finland was conducted over a 1-year period in 2017. A patient was included in the study when the use of helicopter was denied or cancelled due to icing weather conditions. Patients were categorised into two groups based on whether definitive treatment was delayed or not according to previously defined end-points. RESULTS: During the study period the Finnish northernmost HEMS unit received 1940 missions. A total of 391 missions (20%) could not be operated by helicopter because of poor weather conditions. In 142 of these missions (36%) icing was one of the limiting weather factors. The year-round incidence of icing was 7.3/100 missions. A total of 57 patients were included in the analysis. Icing weather conditions, resulting in denied helicopter flights, caused a delay in definitive treatment for 21 patients (37%). Definitive treatment was more often delayed in trauma and internal medicine patients than in neurological patients. Nevertheless, the patients whose definitive treatment was delayed were located closer to the hospital. The estimated time that would have been saved by helicopter transport was more than 60 min for 10 patients with delayed treatment. CONCLUSIONS: In this study the incidence of icing weather conditions was substantial compared to all HEMS missions in year 2017. The delay in definitive treatment was accentuated among trauma and internal medicine patients. During the 1-year study period many patients whose definitive treatment was delayed would have had a notable (> 60 min) time saved by helicopter transport. A helicopter equipped with an adequate ice protection system for the weather conditions in Northern Finland would have shortened the delay in patients' definitive treatment significantly.

Accidental hypothermia: factors related to long-term hospitalization. A retrospective study from northern Finland.

Accidental hypothermia has a low incidence, but is associated with a high mortality rate. Knowledge about concomitant factors, complications, and length of hospital stay is limited. A retrospective cohort study on patients with accidental hypothermia admitted to Oulu University Hospital in Finland, over a 5-year period. Patients were categorized as short-stay patients (7 days or less) and long-stay patients (more than 7 days) according to their length of stay in hospital. From a total of 105 patients, 67 patients were included in the analyses. Alcohol abuse was the most common concomitant factor (54 %). Median length of hospital stay was 4 days, and 16 patients (24 %) stayed in hospital over 7 days (median 15 days). Thirty-day mortality was low (14/105, 13 %). Patients with long-term hospitalization had a lower initial temperature (28.4 versus 31.2 °C, p = 0.011), a lower level of consciousness (GCS score 8.4 versus 12.8, p = 0.003), more severe acidosis (pH 7.08 versus 7.28, p = 0.005, and lactate 7.2 versus 3.9, p = 0.043), and a lower level of platelets (183 versus 242, p = 0.041) on admission compared with short-stay patients. Thirty-six patients (54 %) had at least one complication, and this prolonged median hospital treatment for 2.5 days (p < 0.001). Alcohol is the most common concomitant factor and every fourth patient spends more than 7 days in hospital. Long-term hospitalization is related to a lower core temperature, lower consciousness, more severe lactic acidosis, lower platelet level and infections, rhabdomyolysis, and renal failure.

In-flight breech delivery in Finnish lapland.

Although medical crews may initially approach obstetric transport requests with (at least internal) trepidation, it has been shown that the risk of an in-flight delivery occurring is extremely low, even among patients considered high risk.(1-4) Nevertheless, the greatest concern of helicopter emergency medical service (HEMS) personnel remains the potential for in-flight delivery.(5) Finland is a Northern European country, with a land area almost equivalent to that of the US state of New Mexico. The Finnish HEMS system is managed by FinnHEMS, and there are 6 HEMS units in Finland. The northernmost HEMS unit, FinnHEMS 51, is based at Rovaniemi Airport in Finnish Lapland, which is located within the Arctic Circle; it operates over a remote and sparsely habited area. Finnish Lapland accounts for almost 30% of Finland by area; however, the density of population is low (only 2.0 persons per square kilometer), and the average annual year-round temperature is only -1°C (30°F).(6) So far, there has been only 1 reported in-flight delivery; in 1939, a baby girl was born in an airplane operated by the Finnish Border Guard.(7.)