RESUMO
Objectives: Helicopter emergency medical services (HEMS) have been integral to healthcare systems in developed countries and are becoming more relevant in developing countries. There is extremely scarce information available regarding the typical cost structure and dynamics of HEMS operation; thus, the limitation of knowledge may limit the shapers of national healthcare policy and potential private operators in starting such a service. This study aims to present the cost dynamics of HEMS operation. Methods: A systematic literature review was performed on open-source studies to obtain appropriate data. International benchmarks were found; nevertheless, as Hungarian data did not emerge, a recent investment into HEMS service was analyzed based on publicly available data from the Hungarian Air Ambulance and affiliated companies. The resulting cost base was allocated per flight hour, and a scenario was established with Western European (German) wages and salaries to challenge the aforementioned international examples. Results: The average cost of operation is calculated at EUR 2488 per hour or EUR 41.5 per airborne minute based on average mission duration. This result is quite below the German example of ca. EUR 55.4 per airborne minute and even less than the US and Australian examples, but once the costing model was recalculated with German salaries, the result was extremely similar to the literature review. Nevertheless, comparable international figures need further research, as ownership structure, cost allocation method, and accounting regimes may dramatically impact the cost per airborne minute. Conclusion: The cost of EUR 2488 per flight hour is a good indicator for an hourly rate of operations; however, when deciding on establishing such a service, the model needs to be adjusted for comparable salaries and foreign exchange rates. Nevertheless, if the number of flight hours can be well estimated, the yearly funding needs can be accurately determined using it.
RESUMO
Objective A consensual definition of occupational burnout is currently lacking. We aimed to harmonize the definition of occupational burnout as a health outcome in medical research and reach a consensus on this definition within the Network on the Coordination and Harmonisation of European Occupational Cohorts (OMEGA-NET). Methods First, we performed a systematic review in MEDLINE, PsycINFO and Embase (January 1990 to August 2018) and a semantic analysis of the available definitions. We used the definitions of burnout and burnout-related concepts from the Systematized Nomenclature of Medicine Clinical Terms (SNOMED-CT) to formulate a consistent harmonized definition of the concept. Second, we sought to obtain the Delphi consensus on the proposed definition. Results We identified 88 unique definitions of burnout and assigned each of them to 1 of the 11 original definitions. The semantic analysis yielded a first proposal, further reformulated according to SNOMED-CT and the panelists` comments as follows: "In a worker, occupational burnout or occupational physical AND emotional exhaustion state is an exhaustion due to prolonged exposure to work-related problems". A panel of 50 experts (researchers and healthcare professionals with an interest for occupational burnout) reached consensus on this proposal at the second round of the Delphi, with 82% of experts agreeing on it. Conclusion This study resulted in a harmonized definition of occupational burnout approved by experts from 29 countries within OMEGA-NET. Future research should address the reproducibility of the Delphi consensus in a larger panel of experts, representing more countries, and examine the practicability of the definition.