Characteristics of urban versus rural utilization of the Polish Helicopter Emergency Medical Service in patients with ST-segment elevation myocardial infarction.

BACKGROUND: In patients with acute phase of ST­segment elevation myocardial infarction (STEMI), quick transportation to a specialist therapeutic center is of utmost importance to increase the chances of surviving. AIMS: The objective of this study was to characterize the missions of the Polish Helicopter Emergency Medical Service (HEMS) to patients with STEMI in urban and rural areas and to assess the utilization of air ambulance support as part of an early stage of the therapeutic process. METHODS: This retrospective analysis included 6099 patients with STEMI treated by the Polish HEMS crews from January 2011 to December 2018. RESULTS: The study group included mainly men (68.9%) and persons aged 60 to 79 years (53.9%). The mean (SD) age of the entire group was 64.8 (11.9) years. The level of consciousness measured by the Glasgow Coma Scale score ranged from 13 to 15 (84.8% of patients), the mean (SD) Revised Trauma Score was 11.4 (1.9) points, and the mean (SD) number of points on the National Advisory Committee for Aeronautics scale was 4 (1). In rural areas, the Polish HEMS crews were more frequently dispatched to medical emergencies (99.3% vs 59.6%). Sudden cardiac arrest occurred more often in those areas (6% vs 3.8%), which resulted in the death of the patient (2.4% vs 0.4%; P <0.05 for both). CONCLUSIONS: There were differences in utilization of the Polish HEMS in patients with STEMI in urban and rural areas. The results demonstrated a positive impact of the utilization of HEMS in the early stages of the therapeutic process of these patients.

Neonatal Transport in the Practice of the Crews of the Polish Medical Air Rescue: A Retrospective Analysis.

The aim of the study was to present characteristics of patients transported in incubators by crews of Helicopter Emergency Medical Service (HEMS) and Emergency Medical Service (EMS) of the Polish Medical Air Rescue as well as the character of their missions. The study was based on the method of retrospective analysis of neonatal transports with the use of transport incubators by the crews of HEMS and EMS of the Polish Medical Air Rescue. The study covered 436 medical and rescue transports of premature babies and full-term newborns in the period between January 2012 and December 2018. The study group consisted mainly of male patients (55.05%) who, on the basis of the date of delivery, were qualified as full-term newborns (54.59%). During the transport their average age was 37.53 (standard deviation, SD 43.53) days, and their average body weight was 3121.18 (SD 802.64) grams. A vast majority of neonatal transports were provided with the use of a plane (84.63%), and these were medical transports (79.36%). The average transport time was 49.92 (SD 27.70) minutes with the average distance of 304.27 km (SD 93.05). Significant differences between premature babies and full-term newborns were noticed in terms of age and body weight at the moment of transport, diagnosis based on the International Statistical Classification of Diseases and Related Health Problems (ICD-10), the most commonly used medications (prostaglandin E1, glucose, furosemide, vitamins), National Advisory Committee for Aeronautics (NACA) scale rate as well as the mission type and the presence of an accompanying person.

Polish Helicopter Emergency Medical Service (HEMS) Response to Stroke: A Five-Year Retrospective Study.

BACKGROUND A stroke is a serious life-threatening emergency that requires immediate intervention in an appropriate therapeutic center. The aim of this study was to analyze the time of medical procedures at the scene and changes in the state of stroke patients during transport by HEMS in Poland. The presented research is the first nationwide study covering such a large group of stroke patients, for whom aerial support was used in the therapeutic process. MATERIAL AND METHODS A retrospective cross-sectional study of 48553 missions performed by Polish Medical Air Rescue (PMAR) during the 5-year study period resulted in 3906 stroke patients who, after medical rescue operations by HEMS crew, were transported by helicopters to hospitals. RESULTS Helicopters in 3475 (88.97%) cases were utilized as a support for Ground Emergency Medical Service (GEMS). The maximum duration of HEMS operation from activation to patient transfer to the hospital did not exceed 108 min and the median was 60 min. Over 87% of patients with HEMS reported stroke symptoms and arrived at the medical center with the possibility of implementing thrombolytic therapy. The factor that affected the deterioration of patients' condition was the drawing out of the extent of time spent by the crew at the scene. CONCLUSIONS The use of HEMS in Poland in the case of patients with stroke symptoms ensures fast and professional assistance at the site of the medical emergency as well as safe transport to specialized centers, shortening the time of proper treatment implementation.

Helicopter Emergency Medical Service (HEMS) Response in Rural Areas in Poland: Retrospective Study.

The aim of the study was to identify the characteristics of missions performed by HEMS (Helicopter Emergency Medical Service) crews and the analysis of health problems, which are the most common cause of intervention in rural areas in Poland. The study was conducted using a retrospective analysis based on the medical records of patients provided by the HEMS crew, who were present for the emergencies in rural areas in the period from January 2011 to December 2018. The final analysis included 37,085 cases of intervention by HEMS crews, which accounted for 54.91% of all the missions carried out in the study period. The majority (67.4%) of patients rescued were male, and just under a quarter of those rescued were aged between 50-64 years. Injuries (51.04%) and cardiovascular diseases (36.49%) were the main diagnoses found in the study group. Whereas injuries were significantly higher in the male group and patients below 64 years of age, cardiovascular diseases were higher in women and elderly patients (p < 0.001). Moreover, in the group of women myocardial infarction was significantly more frequent (30.95%) than men, while in the group of men head injuries (27.10%), multiple and multi-organ injuries (25.93%), sudden cardiac arrest (14.52%), stroke (12.19%), and epilepsy (4.95%) was significantly higher. Factors that are associated with the most common health problems of rural patients are: gender and age, as well as the seasons of the year and the values of the Glasgow Coma Scale (GCS), Revised Trauma Score (RTS), and National Advisory Committee for Aeronautics (NACA) used to assess the clinical status of patients.

The strategy of training staff for a new type of helicopter as an element of raising the security level of flight operations.

In 2008, the Polish Medical Air Rescue started replacing its fleet with modern EC135 machines. To ensure the maximum possible safety of the missions performed both in the period of implementing the change and later on, the management prepared a strategy of training its crews to use the new type of helicopter. The analysis of incidents that occurred during 2006-2009 showed that both the human and the technical factors must be carefully considered. Moreover, a risk analysis was conducted to reduce the risk both during general crew training and in the course of particular flight operations. A four-stage strategy of training pilots and crew members was worked out by weighing up all the risks. The analysis of data from 2010 to 2013 confirmed that the risk connected with flying and with all the activities involved in direct support aircraft operations is under control and lowered to an acceptable level.

[Rescue procedures in the major trauma of upper extremities - the role of the Polish medical air rescue in the therapeutic process]. / Postepowanie ratunkowe w ciezkich urazach konczyn górnych - rola lotniczego pogotowia ratunkowego w procesie terapeutycznym.

BACKGROUND: Due to the growing use of various types of industrial and agricultural machinery, occupational accidents are among the most serious ones and quite frequently result in the permanent posttraumnatic disability of the injured person. In Poland, a replantation service has been operating since 2010. Each day, one out of six centres provides emergency replantation service accepting amputation calls from across the country. Patients qualified for replantation often need to be transported from places located even several hundred kilometres from the target hospital. MATERIAL AND METHODS: The analysis covered 174 Helicopter Emergency Medical Service (HEMS) missions and 112 interhospital transports. The data were obtained as a result of a retrospective analysis of the air and medical documentation of 23 460 missions carried out by the Polish Medical Air Rescue (Samodzielny Publiczny Zaklad Opieki Zdrowotnej Lotnicze Pogotowie Ratunkowe - SP ZOZ LPR) aircrafts in the years 2011-2013. RESULTS: In the period under study, the Polish Medical Air Rescue helicopters dressed 135 patients with upper extremity amputations at the scene and transported them to hospitals as part of HEMS missions. At the same time, SP ZOZ LPR aircrafts made 102 interhospital transports. Ninety patients were qualified for treatment in replantation service centres. The average air transport time was 76 min, while the total transport time was 172.3 min. With transport exceeding 300 kin, the average time advantage over the ground transport was approximately 1.5 h. CONCLUSIONS: In justified cases, the use of helicopters and airplanes is an optimal method of transporting patients with the major trauma to upper extremities.