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

BACKGROUND: Trauma 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. METHODS: We 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. RESULTS: Mortality 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. DISCUSSION: Our 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 TYPE: prognostic/therapeutic/diagnostic test.

Short-term and long-term survival in critical patients treated by helicopter emergency medical services in Finland: a registry study of 36 715 patients.

OBJECTIVES: This study aimed to describe the short-term and long-term mortality of patients treated by prehospital critical care teams in Finland. DESIGN AND SETTING: We performed a registry-based retrospective study that included all helicopter emergency medical service (HEMS) dispatches in Finland from 1 January 2012 to 8 September 2019. Mortality data were acquired from the national Population Register Centre to calculate the standardised mortality ratio (SMR). PARTICIPANTS: All patients encountered by Finnish HEMS crews during the study period were included. MAIN OUTCOMES: Mortalities presented at 0 to 1 day, 2 to 30 days, 31 days to 1 year and 1 to 3 years for different medical reasons following the prehospital care. Patients were divided into four groups by age and categorised by gender. The SMR at 2 to 30 days, 31 days to 1 year and 1 to 3 years was calculated for the same groups. RESULTS: Prehospital critical care teams participated in the treatment of 36 715 patients, 34 370 of whom were included in the study. The cumulative all-cause mortality at 30 days was 27.5% and at 3 years was 36.5%. The SMR in different medical categories and periods ranged from 23.2 to 72.2, 18.1 to 22.4, 7.7 to 9.2 and 2.1 to 2.6 in the age groups of 0 to 17 years, 18 to 64 years, 65 to 79 years and ≥80 years, respectively. CONCLUSIONS: We found that the rate of mortality after a HEMS team provides critical care is high and remains significantly elevated compared with the normal population for years after the incident. The mortality is dependent on the medical reason for care and the age of the patient. The long-term overmortality should be considered when evaluating the benefit of prehospital critical care in the different patient groups.

The first seven years of nationally organized helicopter emergency medical services in Finland - the data from quality registry.

BACKGROUND: Helicopter Emergency Medical Services (HEMS) play an important role in prehospital care of the critically ill. Differences in funding, crew composition, dispatch criteria and mission profile make comparison between systems challenging. Several systems incorporate databases for quality control, performance evaluation and scientific purposes. FinnHEMS database was incorporated for such purposes following the national organization of HEMS in Finland 2012. The aims of this study are to describe information recorded in the database, data collection, and operational characteristics of Finnish HEMS during 2012-2018. METHODS: All dispatches of the six Finnish HEMS units recorded in the national database from 2012 to 2018 were included in this observational registry study. Five of the units are physician staffed, and all are on call 24/7. The database follows a template for uniform reporting in physician staffed pre-hospital services, exceeding the recommended variables of relevant guidelines. RESULTS: The study included 100,482 dispatches, resulting in 33,844 (34%) patient contacts. Variables were recorded with little or no missing data. A total of 16,045 patients (16%) were escorted by HEMS to hospital, of which 2239 (2%) by helicopter. Of encountered patients 4195 (4%) were declared deceased on scene. The number of denied or cancelled dispatches was 66,638 (66%). The majority of patients were male (21,185, 63%), and the median age was 57.7 years. The median American Society of Anesthesiologists Physical Scale classification was 2 and Eastern Cooperative Oncology Group performance class 0. The most common reason for response was trauma representing 26% (8897) of the patients, followed by out-of-hospital cardiac arrest 20% (6900), acute neurological reason excluding stroke 13% (4366) and intoxication and related psychiatric conditions 10% (3318). Blunt trauma (86%, 7653) predominated in the trauma classification. CONCLUSIONS: Gathering detailed and comprehensive data nationally on all HEMS missions is feasible. A national database provides valuable insights into where the operation of HEMS could be improved. We observed a high number of cancelled or denied missions and a low percentage of patients transported by helicopter. The medical problem of encountered patients also differs from comparable systems.

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.

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.)