Physician-staffed helicopter emergency medical services augment ground ambulance paediatric airway management in urban areas: a retrospective cohort study.

OBJECTIVES: Paediatric intubation is a high-risk procedure for ground emergency medical services (GEMS). Physician-staffed helicopter EMS (PS-HEMS) may bring additional skills, drugs and equipment to the scene including advanced airway management beyond the scope of GEMS even in urban areas with short transport times. This study aimed to evaluate prehospital paediatric intubation performed by a PS-HEMS when dispatched to assist GEMS in a large urban area and examine how often PS-HEMS provided airway intervention that was not or could not be provided by GEMS. METHODS: We performed a retrospective observational study from July 2011 to December 2016 of a PS-HEMS in a large urban area (Sydney, Australia), which responds in parallel to GEMS. GEMS intubate without adjuvant neuromuscular blockade, whereas the PS-HEMS use neuromuscular blockade and anaesthetic agents. We examined endotracheal intubation success rate, first-look success rate and complications for the PS-HEMS and contrasted this with the advanced airway interventions provided by GEMS prior to PS-HEMS arrival. RESULTS: Overall intubation success rate was 62/62 (100%) and first-look success was 59/62 (95%) in the PS-HEMS-treated group, whereas the overall success rate was 2/7 (29%) for the GEMS group. Peri-intubation hypoxia was documented in 5/65 (8%) of the PS-HEMS intubation attempts but no other complications were reported. However, 3/7 (43%) of the attempted intubations by GEMS were oesophageal intubations, two of which were unrecognised. CONCLUSIONS: PS-HEMS have high success with low complication rates in paediatric prehospital intubation. Even in urban areas with rapid GEMS response, PS-HEMS activated in parallel can provide safe and timely advanced prehospital airway management for seriously ill and injured children beyond the scope of GEMS practice. Review of GEMS airway management protocols and the PS-HEMS case identification and dispatch system in Sydney is warranted.

Integrated locating of helicopter stations and helipads for wounded transfer under demand location uncertainty.

Health emergency medical service (HEMS) plays an important role in reducing injuries by providing advanced medical care in the shortest time and reducing the transfer time to advanced treatment centers. In the regions without ground relief coverage, it would be faster to transfer emergency patients to the hospital by a helicopter. In this paper, an integer nonlinear programming model is presented for the integrated locating of helicopter stations and helipads by considering uncertainty in demand points. We assume three transfer modes: (1) direct transfer by an ambulance, (2) transfer by an ambulance to a helicopter station and then to the hospital by a helicopter, (3) transfer by an ambulance to a predetermined point and then to the hospital by a helicopter. We also assume that demands occur in a square-shaped area, in which each side follows a uniform distribution. It is also assumed that demands in an area decrease errors in the distances between each two cities. The purpose of this model is to minimize the transfer time from demand points to the hospital by considering different modes. The proposed model is examined in terms of validity and applicability in Lorestan Province and a sensitivity analysis is also conducted on the total allocated budget.

Cross-sectional investigation of HEMS activities in Europe: a feasibility study.

OBJECTIVES: To gather information on helicopter emergency medical services (HEMSs) activities across Europe. METHODS: Cross-sectional data-collection on daily (15 November 2013) activities of a sample of European HEMSs. A web-based questionnaire with both open and closed questions was used, developed by experts of the European Prehospital Research Alliance (EUPHOREA). RESULTS: We invited 143 bases from 11 countries; 85 (60%) reported base characteristics only and 73 (51%) sample-day data too. The variety of base characteristics was enormous; that is, the target population ranged from 94.000 to 4.500.000. Of 158 requested primary missions, 62 (0.82 per base) resulted in landing. Cardiac aetiology (36%) and trauma (36%) prevailed, mostly of life-threatening severity (43%, 0.64 per mission). Had HEMS been not dispatched, patients would have been attended by another physician in 67% of cases, by paramedics in 24%, and by nurses in 9%. On-board physicians estimated to have caused a major decrease of death risk in 47% of missions, possible decrease in 22%, minor benefit in 17%, no benefit in 11%, and damage in 3%. Earlier treatment and faster transport to hospital were the main reasons for benefit. The most frequent therapeutic procedure was drug administration (78% of missions); endotracheal intubation occurred in 25% of missions and was an option hardly offered by ground crews. CONCLUSIONS: The study proved feasible, establishing an embryonic network of European HEMS. The participation rate was low and limits the generalizability of the results. Fortunately, because of its cross-sectional characteristics and the handy availability of the web platform, the study is easily repeatable with an enhanced network.

The effect of adding a second helicopter on trauma-related mortality in a county-based trauma system.

OBJECTIVES: Despite conflicting evidence regarding its efficacy, helicopter transportation of trauma victims is widespread. We determined the effect of adding a second helicopter to a countywide emergency medicine system on trauma-related mortality. METHODS: A before-and-after trial design was used to compare hospital mortality before and after introducing a second helicopter to the eastern end of Suffolk County, New York, in 2001 aimed at reducing transport times to the regional trauma center. Outcomes before and after introducing the second helicopter were compared with parametric or nonparametric tests as appropriate. RESULTS: A total of 1,551 trauma patients were included in this study from June 1996 to May 2006, with 705 in the single-helicopter period and 846 in the two-helicopter period. Mean ages, gender distributions, and mean Injury Severity Scores (ISSs) were similar between groups. Total mortality significantly decreased after the addition of the second helicopter (16.2% before vs. 11.9% after; p = 0.02). CONCLUSIONS: Introduction of a second helicopter to the east end of Long Island was associated with a significant reduction in the total trauma mortality.

Access to trauma centers in the United States.

CONTEXT: Previous studies have reported that the number and distribution of trauma centers are uneven across states, suggesting large differences in access to trauma center care. OBJECTIVE: To estimate the proportion of US residents having access to trauma centers within 45 and 60 minutes. DESIGN AND SETTING: Cross-sectional study using data from 2 national databases as part of the Trauma Resource Allocation Model for Ambulances and Hospitals (TRAMAH) project. Trauma centers, base helipads, and block group population were counted for all 50 states and the District of Columbia as of January 2005. MAIN OUTCOME MEASURES: Percentages of national, regional, and state populations having access to all 703 level I, II, and III trauma centers in the United States by either ground ambulance or helicopter within 45 and 60 minutes. RESULTS: An estimated 69.2% and 84.1% of all US residents had access to a level I or II trauma center within 45 and 60 minutes, respectively. The 46.7 million Americans who had no access within an hour lived mostly in rural areas, whereas the 42.8 million Americans who had access to 20 or more level I or II trauma centers within an hour lived mostly in urban areas. Within 45 and 60 minutes, respectively, 26.7% and 27.7% of US residents had access to level I or II trauma centers by helicopter only and 1.9% and 3.1% of US residents had access to level I or II centers only from trauma centers or base helipads outside their home states. CONCLUSION: Selecting trauma centers based on geographic need, appropriately locating medical helicopter bases, and establishing formal agreements for sharing trauma care resources across states should be considered to improve access to trauma care in the United States.

No time to spare: improving access to trauma care.

Since the September 11 attacks, policymakers are paying increasing attention to the adequacy of the U.S. trauma care system to handle potential mass casualty incidents. This attention has led to questions about how well the trauma system covers the population for day-to-day trauma, such as motor vehicle accidents and gunshot wounds. Although the number of trauma centers has increased in the last decade, no national plan exists to assure that everyone has timely access to a specialized trauma center if needed. This Issue Brief summarizes a new study that estimates the proportion of residents that can reach a trauma center by ground or air ambulance within one hour of where they live, using objective measures of travel times and distances.

If all ambulances could fly: putting provincial standards of emergency care access to the test in Northern British Columbia.

INTRODUCTION: Geographic access to emergency treatment remains an important public policy concern as rural emergency medical systems respond to various pressures to centralize services. Geographical Information Systems (GIS) are effective tools to determine what proportion of a given population is adequately served by existing or proposed service distributions. METHODS: This study compares 2 GIS approaches to determining whether recent standards of emergency care access established by the British Columbia Ministry of Health Services are being met in Northern British Columbia. In particular, we compare results obtained using the more commonly used straight-line, or "as the crow flies," method with those obtained using a more sophisticated method that estimates travel time using digitally referenced road network data. RESULTS: Both methods reveal that provincial standards of emergency access are not being met in Northern British Columbia. CONCLUSION: In terms of comparing the 2 approaches, the network technique indicated a lower level of access and was more accurate in identifying populations residing inside and outside the "golden hour" of emergency care.

Injury mortality following the loss of air medical support for rural interhospital transport.

OBJECTIVES: This study evaluated variation in mortality among interfacility transfers three years before and after discontinuation of a rotor-wing transport service. METHODS: A retrospective cohort assessment was conducted among severely injured patients transferred from four rural hospitals to a single tertiary center in regions with continued versus discontinued rotor-wing service. Thirty-day mortality following discharge from the receiving tertiary facility served as the primary outcome measure. RESULTS: Discontinuation of rotor-wing transport decreased interfacility transfers and increased transfer time. Transferred patients were four times more likely to die after (compared with before) rotor-wing service was discontinued (p = 0.05). No difference was noted in the region with continued rotor-wing service [odds ratio (OR) = 0.53, p = 0.47]. CONCLUSIONS: Injury mortality increased with loss of air transport for interfacility transfer in a rural area.

To the rescue: optimally locating trauma hospitals and helicopters.

Injury (trauma) is the leading cause of death in the United States for people younger than 45 years of age. Each day, more than 170,000 men, women, and children are injured severely enough to seek medical care. About 400 of these people will die and another 200 will sustain a long-term disability as a result of their injuries. An estimated 20-40% of trauma-related deaths could be prevented if all Americans lived in communities that were served by a well-organized system of trauma care. This Issue Brief describes a new computer model that can help State and regional policymakers decide where to place designated trauma hospitals and helicopter depots to maximize their residents' access to trauma care.

Helicopter medical retrieval in Sydney, New South Wales.

Undoubtedly the main attraction of this job is the interest of never knowing what will happen next! Primary response to an MVA allows one to experience the atmosphere and deal with clinical situations in an alien setting. This broadens ones perspective and has taught me never to be tempted to criticise a paramedic bringing a patient into a resus room. The same is true of interhospital transfers where tact and diplomacy can be tested as well as clinical skills. On the negative side the unpredictability can be difficult domestically (a primary at 17555 means you will be at least two hours late home) and there can be long and dull days when nothing happens. A lot of time is spent transporting post arrest patients from one hospital to another to find an ICU bed. In military medicine it is difficult to envisage a future conflict when severely injured casualties would not require transport both locally and over long distances. This job provides an ideal opportunity to become confident with transporting critically ill patients.

Avionics and airframe options: current usage and future plans.

The 1994 Avionics and Airframe Survey was sent to 178 chief or lead pilots of helicopter emergency medical services (HEMS) programs in October 1993, and 100 (56%) were returned. Sixty-four programs (64%) reported that they operate one helicopter exclusively for EMS, 24 (24%) operate two, and 12 (12%) reported using three or more aircraft. Interestingly, the reported percentage of programs with two or more exclusive helicopters continues to rise, increasing by 5.6% to 36%.

Accessibility and distribution of the Norwegian National Air Emergency Service: 1988-1998.

OBJECTIVE: To evaluate the accessibility and distribution of the Norwegian National Air Emergency Service in the 10-year period from 1988 to 1998. MATERIAL AND METHODS: The primary material was annual standardized activity data that included all helicopter missions. A multivariate model of determinants for use of the helicopter service was computed by linear regression. Accessibility was measured as the percentage of the population reached in different flying times, and we evaluated the service using a simulation of alternative locations for the helicopter bases. RESULTS: The helicopter service (HEMS) has short access times, with a mean reaction time of 8 minutes and a mean response time of 26 minutes for acute missions. Nearly all patients (98%) are reached within 1 hour. A simulation that tested alternative locations of the helicopter bases compared with current locations showed no increase in accessibility. The use of the service shows large regional differences. Multivariate analyses showed that the distances of the patients from the nearest helicopter base and the nearest hospital are significant determinants for the use of HEMS. CONCLUSION: Establishment of a national service has given the Norwegian population better access to highly qualified prehospital emergency services. Furthermore, the HEMS has a compensating effect in adjusting for differences in traveling distances to a hospital. Safety, cost-containment, and gatekeeper functions remain challenges.

VII Symposium Nacional de Medicina Aeroespacial: Santiago de Compostela, 19 y 20 de octubre de 2006 / No disponible

No disponible