1
|
Noack EM, Bramesfeld A, Schmid S, Schröder D, Müller F. [Rescue Missions with Patients with Psychiatric and Psychosocial Symptoms: An Analysis from Eastern Lower Saxony]. PSYCHIATRISCHE PRAXIS 2024. [PMID: 38810903 DOI: 10.1055/a-2310-5534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
OBJECTIVE Characterization of medical emergencies of patients with psychiatric symptoms or in psychosocial crisis. METHODS Analysis of emergency medical services (EMS) mission logs from four German EMS stations of patients aged 12-65 from 2019 to 2020. RESULTS 23.4% of missions involved patients with psychiatric or psychosocial symptoms (1.6% psychotic, 3.0% suicidal, 7.1% psychosocial crisis, 15.7% intoxicated). On average, these patients were younger than those with other symptoms. 48.9% exhibited additional somatic complaints. The COVID-19 pandemic showed only little impact on the frequency of such emergencies. CONCLUSION Psychiatric and psychosocial symptoms account for a significant proportion of rescue missions in our sample. Managing psychiatric and psychosocial emergencies should be an integral part of the training of medical and paramedical staff.
Collapse
Affiliation(s)
- Eva Maria Noack
- Institut für Allgemeinmedizin, Universitätsmedizin Göttingen
| | - Anke Bramesfeld
- Institut für Epidemiologie, Sozialmedizin und Gesundheitssystemforschung, Medizinische Hochschule Hannover
| | | | | | - Frank Müller
- Institut für Allgemeinmedizin, Universitätsmedizin Göttingen
| |
Collapse
|
2
|
Wekre SL, Uleberg O, Næss LE, Haugland H. Mortality rates in Norwegian HEMS-a retrospective analysis from Central Norway. Scand J Trauma Resusc Emerg Med 2024; 32:29. [PMID: 38627817 PMCID: PMC11022357 DOI: 10.1186/s13049-024-01202-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 04/04/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Helicopter Emergency Medical Services (HEMS) provide rapid and specialized care to critically ill or injured patients. Norwegian HEMS in Central Norway serves an important role in pre-hospital emergency medical care. To grade the severity of patients, HEMS uses the National Advisory Committee for Aeronautics' (NACA) severity score. The objective of this study was to describe the short- and long term mortality overall and in each NACA-group for patients transported by HEMS Trondheim using linkage of HEMS and hospital data. METHODS The study used a retrospective cohort design, aligning with the STROBE recommendations. Patient data from Trondheim HEMS between 01.01.2017 and 31.12.2019 was linked to mortality data from a hospital database and analyzed. Kaplan Meier plots and cumulative mortality rates were calculated for each NACA group at day one, day 30, and one year and three years after the incident. RESULTS Trondheim HEMS responded to 2224 alarms in the included time period, with 1431 patients meeting inclusion criteria for the study. Overall mortality rates at respective time points were 10.1% at day one, 13.4% at 30 days, 18.5% at one year, and 22.3% at three years. The one-year cumulative mortality rates for each NACA group were as follows: 0% for NACA 1 and 2, 2.9% for NACA 3, 10.1% for NACA 4, 24.7% for NACA 5 and 49.5% for NACA 6. Statistical analysis with a global log-rank test indicated a significant difference in survival outcomes among the groups (p < 2⋅10- 16). CONCLUSION Among patients transported by Trondheim HEMS, we observed an incremental rise in mortality rates with increasing NACA scores. The study further suggests that a one-year follow-up may be sufficient for future investigations into HEMS outcomes.
Collapse
Affiliation(s)
- Stian Lande Wekre
- Norwegian University of Science and Technology (NTNU), Trondheim, NO-7018, Norway.
| | - Oddvar Uleberg
- Department of Emergency Medicine and Pre-Hospital Services, St. Olav's University Hospital, Trondheim, Norway
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| | - Lars Eide Næss
- Department of Emergency Medicine and Pre-Hospital Services, St. Olav's University Hospital, Trondheim, Norway
- Department of Research and Development, Norwegian Air Ambulance Foundation, Oslo, Norway
| | - Helge Haugland
- Department of Emergency Medicine and Pre-Hospital Services, St. Olav's University Hospital, Trondheim, Norway
- Department of Research and Development, Norwegian Air Ambulance Foundation, Oslo, Norway
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| |
Collapse
|
3
|
Eichinger M, Reiterer S, Rief M, Eichlseder M, Pichler A, Zoidl P, Prause G. Use of bitemporal NACA score documentation in prehospital emergency medical services- a retrospective study. Int J Emerg Med 2024; 17:36. [PMID: 38454355 PMCID: PMC10918989 DOI: 10.1186/s12245-024-00605-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 02/22/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND The assessment of illness severity in the prehospital setting is essential for guiding appropriate medical interventions. The National Advisory Committee for Aeronautics (NACA) score is a validated tool commonly used for this purpose. However, the potential benefits of using bitemporal documentation of NACA scores to capture the dynamic changes in emergency situations remain uncertain. The objective of this study was to evaluate the potential benefit of bitemporal NACA score documentation in the prehospital setting, specifically in assessing the dynamic changes of emergencies and facilitating quality improvement through enhanced documentation practices. METHODS In this retrospective study, data from prehospital emergency patients were analyzed who received care from the physician response unit between January 1, 2018, and May 31, 2021. Patient demographics, NACA scores, indications for emergency care, and changes in NACA scores were extracted from medical records. Statistical analyses were performed to examine the associations between NACA scores, emergency categories, indications, and changes in NACA scores. RESULTS The study included 4005 patients, predominantly categorized as NACA III (33.7% at initial assessment, 41.8% at subsequent assessment) and NACA IV (31.6% at initial assessment, 22.4% at subsequent assessment). There was a significant improvement in NACA scores during the provision of prehospital care (p < 0.01). Notably, prehospital emergencies attributed to internal medical, neurological, traumatic, and paediatric causes demonstrated significant improvements in NACA scores (p < 0.01). Gender-specific differences were also observed. CONCLUSION Our study suggests that the bitemporal documentation of NACA scores can be advantageous in the prehospital setting and may have implications for research, practice, and policy.
Collapse
Affiliation(s)
- Michael Eichinger
- Division of Anaesthesiology and Intensive Care Medicine 1, Medical University of Graz, Auenbruggerplatz 5, Graz, A-8036, Austria
| | - Sandro Reiterer
- Division of Anaesthesiology and Intensive Care Medicine 2, Medical University of Graz, Auenbruggerplatz 5, Graz, A-8036, Austria
| | - Martin Rief
- Division of Anaesthesiology and Intensive Care Medicine 1, Medical University of Graz, Auenbruggerplatz 5, Graz, A-8036, Austria.
| | - Michael Eichlseder
- Division of Anaesthesiology and Intensive Care Medicine 1, Medical University of Graz, Auenbruggerplatz 5, Graz, A-8036, Austria
| | - Alexander Pichler
- Division of Anaesthesiology and Intensive Care Medicine 1, Medical University of Graz, Auenbruggerplatz 5, Graz, A-8036, Austria
| | - Philipp Zoidl
- Division of Anaesthesiology and Intensive Care Medicine 1, Medical University of Graz, Auenbruggerplatz 5, Graz, A-8036, Austria
| | - Gerhard Prause
- Division of Anaesthesiology and Intensive Care Medicine 1, Medical University of Graz, Auenbruggerplatz 5, Graz, A-8036, Austria
| |
Collapse
|
4
|
Breindahl N, Wolthers SA, Møller TP, Blomberg SNF, Steinmetz J, Christensen HC. Characteristics and critical care interventions in drowning patients treated by the Danish Air Ambulance from 2016 to 2021: a nationwide registry-based study with 30-day follow-up. Scand J Trauma Resusc Emerg Med 2024; 32:17. [PMID: 38448994 PMCID: PMC10916225 DOI: 10.1186/s13049-024-01189-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 02/26/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Improving oxygenation and ventilation in drowning patients early in the field is critical and may be lifesaving. The critical care interventions performed by physicians in drowning management are poorly described. The aim was to describe patient characteristics and critical care interventions with 30-day mortality as the primary outcome in drowning patients treated by the Danish Air Ambulance. METHODS This retrospective cohort study with 30-day follow-up identified drowning patients treated by the Danish Air Ambulance from January 1, 2016, through December 31, 2021. Drowning patients were identified using a text-search algorithm (Danish Drowning Formula) followed by manual review and validation. Operational and medical data were extracted from the Danish Air Ambulance database. Descriptive analyses were performed comparing non-fatal and fatal drowning incidents with 30-day mortality as the primary outcome. RESULTS Of 16,841 dispatches resulting in a patient encounter in the six years, the Danish Drowning Formula identified 138 potential drowning patients. After manual validation, 98 drowning patients were included in the analyses, and 82 completed 30-day follow-up. The prehospital and 30-day mortality rates were 33% and 67%, respectively. The National Advisory Committee for Aeronautics severity scores from 4 to 7, indicating a critical emergency, were observed in 90% of the total population. They were significantly higher in the fatal versus non-fatal group (p < 0.01). At least one critical care intervention was performed in 68% of all drowning patients, with endotracheal intubation (60%), use of an automated chest compression device (39%), and intraosseous cannulation (38%) as the most frequently performed interventions. More interventions were generally performed in the fatal group (p = 0.01), including intraosseous cannulation and automated chest compressions. CONCLUSIONS The Danish Air Ambulance rarely treated drowning patients, but those treated were severely ill, with a 30-day mortality rate of 67% and frequently required critical care interventions. The most frequent interventions were endotracheal intubation, automated chest compressions, and intraosseous cannulation.
Collapse
Affiliation(s)
- Niklas Breindahl
- Prehospital Center Region Zealand, Ringstedgade 61, 13, 4700, Næstved, Denmark.
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
- Department of Neonatal and Paediatric Intensive Care, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
| | - Signe A Wolthers
- Prehospital Center Region Zealand, Ringstedgade 61, 13, 4700, Næstved, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Thea P Møller
- Prehospital Center Region Zealand, Ringstedgade 61, 13, 4700, Næstved, Denmark
- Department of Anesthesiology and Intensive Care Medicine, Holbæk Hospital, Holbæk, Region Zealand, Denmark
| | - Stig N F Blomberg
- Prehospital Center Region Zealand, Ringstedgade 61, 13, 4700, Næstved, Denmark
| | - Jacob Steinmetz
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Danish Air Ambulance, Brendstrupgårdsvej 7, 8200, Aarhus, Denmark
- Department of Anaesthesia, Centre of Head and Orthopaedics, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
- Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Helle C Christensen
- Prehospital Center Region Zealand, Ringstedgade 61, 13, 4700, Næstved, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
5
|
Benedikt G. Rock falls while high-altitude mountaineering - More often in the last years? Evidence from the Swiss alps. Heliyon 2024; 10:e25413. [PMID: 38327473 PMCID: PMC10847909 DOI: 10.1016/j.heliyon.2024.e25413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 01/25/2024] [Accepted: 01/25/2024] [Indexed: 02/09/2024] Open
Abstract
Objectives One risk while high-altitude mountaineering despite falls or stranding are rock falls. Due to the climatic change such events might have become potentially more common yielding to the research question to elucidate rock falls while high-altitude mountaineering in the Alps of Switzerland. Design A retrospective analysis was conducted from the central registry of the Swiss Alpine Club (SAC) during the observational period from 2009 to 2020. Results A total of 266 cases of rock falls was detected during an observational period yielding to in average 22.2 ± 7 emergency cases per year. No increase nor decrease of the number of cases over time (R2 = 0.0019) was detected. The average age of a victim was 50.2 ± 18.6 years. The mean of the NACA-Score (NACA = National Advisory Committee for Aeronautics) was 2.7 ± 1.4 implying a moderate injury, however not life threatening. The NACA-Score slightly decreased over time indicating that emergencies have become less severe (R2 = 0.1379). The injury pattern was relatively equal distributed between upper and lower extremity. Conclusions The slight decrease in the severity of the events might be a consequence of increasing security standards over the observational period. The fact that the average victim of an emergency action was around 50 years, might indicate that stone falls are a constant risk as it can be suggested that alpinists with this age are more risk averse than younger alpinists. As findings were analyzed in a retrospective design, a quasi-prospective design might be helpful while directly analyzing emergencies after occurrence with interviews of involved persons. These hints could be used constructively in order to improve security recommendations.
Collapse
Affiliation(s)
- Gasser Benedikt
- Departement für Sport, Bewegung und Gesundheit, Abteilung Rehabilitative und Regenerative Sportmedizin, Universität Basel, Birsstrasse 320B, CH-4052, Basel, Switzerland
| |
Collapse
|
6
|
Krammel M, Frimmel N, Hamp T, Grassmann D, Widhalm H, Verdonck P, Reisinger C, Sulzgruber P, Schnaubelt S. Outcomes and potential for improvement in the prehospital treatment of penetrating chest injuries in a European metropolitan area: A retrospective analysis of 2009 - 2017. Injury 2024; 55:110971. [PMID: 37544864 DOI: 10.1016/j.injury.2023.110971] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 07/08/2023] [Accepted: 08/01/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND Trauma is the leading cause of death in patients <45 years living in high-resource settings. However, penetrating chest injuries are still relatively rare in Europe - with an upwards trend. These cases are of particular interest to emergency medical services (EMS) due to available invasive treatment options like chest tube placement or resuscitative thoracotomy. To date, there is no sufficient data from Austria regarding penetrating chest trauma in a metropolitan area, and no reliable source to base decisions regarding further skill proficiency training on. METHODS For this retrospective observational study, we screened all trauma emergency responses of the Viennese EMS between 01/2009 and 12/2017 and included all those with a National Advisory Committee for Aeronautics (NACA) score ≥ IV (= potentially life-threatening). Data were derived from EMS mission documentations and hospital files, and for those cases with the injuries leading to cardiopulmonary resuscitation (CPR), we assessed the EMS cardiac arrest registry and consulted a forensic physician. RESULTS We included 480 cases of penetrating chest injuries of NACA IV-VII (83% male, 64% > 30 years old, 74% stab wounds, 16% cuts, 8% gunshot wounds, 56% inflicted by another party, 26% self-inflicted, 18% unknown). In the study period, the incidence rose from 1.4/100,000 to 3.5/100,000 capita, and overall, about one case was treated per week. In the cases with especially severe injury patterns (= NACA V-VII, 43% of total), (tension-)pneumothorax was the most common injury (29%). The highest mortality was seen in injuries to pulmonary vessels (100%) or the heart (94%). Fifty-eight patients (12% of total) deceased, whereas in 15 cases, the forensic physician stated survival could theoretically have been possible. However, only five of these CPR patients received at least unilateral thoracostomy. Regarding all penetrating chest injuries, thoracostomy had only been performed in eight patients. CONCLUSIONS Severe cases of penetrating chest trauma are rare in Vienna and happened about once a week between 2009 and 2017. Both incidence and case load increased over the years, and potentially life-saving invasive procedures were only reluctantly applied. Therefore, a structured educational and skill retention approach aimed at both paramedics and emergency physicians should be implemented. TRIAL REGISTRATION Retrospective analysis without intervention.
Collapse
Affiliation(s)
| | - Nikolaus Frimmel
- Dept. of Anaesthesia, General Intensive Care Medicine, and Pain Therapy, Medical University of Vienna, Vienna, Austria
| | - Thomas Hamp
- Emergency Medical Service Vienna, Vienna, Austria; Dept. of Anaesthesia, General Intensive Care Medicine, and Pain Therapy, Medical University of Vienna, Vienna, Austria
| | | | - Harald Widhalm
- Dept. of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Philip Verdonck
- Dept. of Emergency Medicine, Antwerp University Hospital, Edegem, Belgium
| | | | - Patrick Sulzgruber
- Division of Cardiology, Dept. of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Sebastian Schnaubelt
- Dept. of Emergency Medicine, Antwerp University Hospital, Edegem, Belgium; Dept. of Emergency Medicine, Medical University of Vienna, Vienna, Austria.
| |
Collapse
|
7
|
Betend R, Suppan L, Chan M, Regard S, Sarasin F, Fehlmann CA. Association between prehospital physician clinical experience and discharge at scene - retrospective cohort study. Swiss Med Wkly 2023; 153:3533. [PMID: 38579323 DOI: 10.57187/s.3533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND Clinical experience has been shown to affect many patient-related outcomes but its impact in the prehospital setting has been little studied. OBJECTIVES To determine whether rates of discharge at scene, handover to paramedics and supervision are associated with clinical experience. DESIGN, SETTINGS AND PARTICIPANTS A retrospective study, performed on all prehospital interventions carried out by physicians working in a mobile medical unit ("service mobile d'urgence et de réanimationˮ [SMUR]) at Geneva University Hospitals between 1 January 2010 and 31 December 2019. The main exclusion criteria were phone consultations and major incidents with multiple casualties. EXPOSURE The exposure was the clinical experience of the prehospital physician at the time of the intervention, in number of years since graduation. OUTCOME MEASURES AND ANALYSIS The main outcome was the rate of discharge at scene. Secondary outcomes were the rate of handover to paramedics and the need for senior supervision. Outcomes were tabulated and multilevel logistic regression was performed to take into account the cluster effect of physicians. RESULTS In total, 48,368 adult patients were included in the analysis. The interventions were performed by 219 different physicians, most of whom were male (53.9%) and had graduated in Switzerland (82.7%). At the time of intervention, mean (standard deviation [SD]) level of experience was 5.2 (3.3) years and the median was 4.6 (interquartile range [IQR]: 3.4-6.0). The overall discharge at scene rate was 7.8% with no association between clinical experience and discharge at scene rate. Greater experience was associated with a higher rate of handover to paramedics (adjusted odds ratio [aOR]: 1.17, 95% confidence interval [CI]: 1.13-1.21) and less supervision (aOR: 0.85, 95% CI: 0.82-0.88). CONCLUSION In this retrospective study, there was no association between level of experience and overall rate of discharge at scene. However, greater clinical experience was associated with higher rates of handover to paramedics and less supervision.
Collapse
Affiliation(s)
- Romain Betend
- Division of Emergency, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals and Faculty of Medicine University of Geneva, Geneva, Switzerland
| | - Laurent Suppan
- Division of Emergency, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals and Faculty of Medicine University of Geneva, Geneva, Switzerland
| | - Michele Chan
- Division of Emergency, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals and Faculty of Medicine University of Geneva, Geneva, Switzerland
| | - Simon Regard
- Division of Emergency, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals and Faculty of Medicine University of Geneva, Geneva, Switzerland
- Division of Cantonal Physician, General Directorate of Health, Department of Security, Population and Health, Geneva, Switzerland
| | - François Sarasin
- Division of Emergency, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals and Faculty of Medicine University of Geneva, Geneva, Switzerland
| | - Christophe A Fehlmann
- Division of Emergency, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals and Faculty of Medicine University of Geneva, Geneva, Switzerland
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| |
Collapse
|
8
|
Ulvin OE, Skjærseth EÅ, Krüger AJ, Thorsen K, Nordseth T, Haugland H. Can video communication in the emergency medical communication centre improve dispatch precision? A before-after study in Norwegian helicopter emergency medical services. BMJ Open 2023; 13:e077395. [PMID: 37899141 PMCID: PMC10618992 DOI: 10.1136/bmjopen-2023-077395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 10/03/2023] [Indexed: 10/31/2023] Open
Abstract
OBJECTIVES Dispatching helicopter emergency medical services (HEMS) to the patients with the greatest medical or logistical benefit remains challenging. The introduction of video calls (VC) in the emergency medical communication centres (EMCC) could provide additional information for EMCC operators and HEMS physicians when assessing the need for HEMS dispatch. The aim of this study was to evaluate the impact from VC in the EMCC on HEMS dispatch precision. DESIGN An observational before-after study. SETTING The regional EMCC and one HEMS base in Mid-Norway. PARTICIPANTS EMCC operators and HEMS physicians at the EMCC and HEMS base in Trondheim, Norway. INTERVENTION In January 2022, VC became available in emergency calls in Trondheim EMCC. Data were collected from 2020 2021 (pre-intervention) and 2022 (post-intervention). PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was the proportion of seriously ill or injured HEMS patients, defined as a National Advisory Committee for Aeronautics (NACA) score between 4 and 7. The secondary outcome was the proportion of inappropriate dispatches, defined as missions with neither provision of additional competence nor any logistical contribution based on quality indicators for physician-staffed emergency medical services. RESULTS 811 and 402 HEMS missions with patient contact were included in the pre- and post-intervention group, respectively. The proportion of missions with NACA 4-7 was not significantly changed after the intervention (OR 1.21, 95% CI 0.92 to 1.61, p=0.17). There was no significant change in HEMS alarm times between the pre- and post-intervention groups (7.6 min vs 6.4 min, p=0.15). The proportion of missions with neither medical nor logistical benefit was significantly lower in the post-intervention group (28.4% vs 40.3%, p=0.007). CONCLUSION The results from this study indicate that VC is a promising, feasible and safe tool for EMCC operators in the complex HEMS dispatch process.
Collapse
Affiliation(s)
- Ole Erik Ulvin
- Department of Research and Development, Norwegian Air Ambulance Foundation, Oslo, Norway
- Department of Emergency Medicine and Pre-hospital Services, St Olav's University Hospital, Trondheim, Norway
- Faculty of Medicine and Health Sciences, Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Anaesthesia and Intensive Care Medicine, St. Olav's University Hospital, Trondheim, Norway
| | - Eivinn Årdal Skjærseth
- Department of Emergency Medicine and Pre-hospital Services, St Olav's University Hospital, Trondheim, Norway
| | - Andreas J Krüger
- Department of Research and Development, Norwegian Air Ambulance Foundation, Oslo, Norway
- Department of Emergency Medicine and Pre-hospital Services, St Olav's University Hospital, Trondheim, Norway
- Faculty of Medicine and Health Sciences, Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Kjetil Thorsen
- Department of Research and Development, Norwegian Air Ambulance Foundation, Oslo, Norway
| | - Trond Nordseth
- Faculty of Medicine and Health Sciences, Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Anaesthesia and Intensive Care Medicine, St. Olav's University Hospital, Trondheim, Norway
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| | - Helge Haugland
- Department of Research and Development, Norwegian Air Ambulance Foundation, Oslo, Norway
- Department of Emergency Medicine and Pre-hospital Services, St Olav's University Hospital, Trondheim, Norway
| |
Collapse
|
9
|
Jakob DA, Müller M, Jud S, Albrecht R, Hautz W, Pietsch U. The forgotten cohort-lessons learned from prehospital trauma death: a retrospective cohort study. Scand J Trauma Resusc Emerg Med 2023; 31:37. [PMID: 37550763 PMCID: PMC10405424 DOI: 10.1186/s13049-023-01107-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 07/31/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND Trauma related deaths remain a relevant public health problem, in particular in the younger male population. A significant number of these deaths occur prehospitally without transfer to a hospital. These patients, sometimes termed "the forgotten cohort", are usually not included in clinical registries, resulting in a lack of information about prehospitally trauma deaths. The aim of the present study was to compare patients who died prehospital with those who sustained life-threatening injuries in order to analyze and potentially improve prehospital strategies. METHODS This cohort study included all primary operations carried out by Switzerland's largest helicopter emergency medical service (HEMS) between January 1, 2011, and December 31, 2021. We included all adult trauma patients with life-threatening or fatal conditions. The outcome of this study is the vital status of the patient at the end of mission, i.e. fatal or life-threatening. Injury, rescue characteristics, and interventions of the forgotten trauma cohort, defined as patients with a fatal injury (NACA score of VII), were compared with life-threatening injuries (NACA score V and VI). RESULTS Of 110,331 HEMS missions, 5534 primary operations were finally analyzed, including 5191 (93.8%) life-threatening and 343 (6.2%) fatal injuries. More than two-thirds of patients (n = 3772, 68.2%) had a traumatic brain injury without a significant difference between the two groups (p > 0.05). Thoracic trauma (44.6% vs. 28.7%, p < 0.001) and abdominal trauma (22.2% vs. 16.1%, p = 0.004) were more frequent in fatal missions whereas pelvic trauma was similar between the two groups (13.4% vs. 12.9%, p = 0.788). Pneumothorax decompression rate (17.2% vs. 3.7%, p < 0.001) was higher in the forgotten cohort group and measures for bleeding control (15.2% vs. 42.7%, p < 0.001) and pelvic belt application (2.9% vs. 13.1% p < 0.001) were more common in the life-threating injury group. CONCLUSION Chest decompression rates and measures for early hemorrhage control are areas for potential improvement in prehospital care.
Collapse
Affiliation(s)
- Dominik A Jakob
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland.
| | - Martin Müller
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland
| | - Sebastian Jud
- Department of Anesthesiology and Intensive Care Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Roland Albrecht
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland
- Department of Anesthesiology and Intensive Care Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
- Swiss Air-Ambulance, Rega (Rettungsflugwacht/Guarde Aérienne), Zurich, Switzerland
| | - Wolf Hautz
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland
| | - Urs Pietsch
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland
- Department of Anesthesiology and Intensive Care Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
- Swiss Air-Ambulance, Rega (Rettungsflugwacht/Guarde Aérienne), Zurich, Switzerland
| |
Collapse
|
10
|
Collins D, Crickmer M, Brolly K, Abrams D, Ritchie A, Milsom W. Epidemiology of Emergency Medical Search and Rescue in the North Shore Mountains of Vancouver, Canada, from 1995 to 2020. Wilderness Environ Med 2023; 34:55-62. [PMID: 36710126 DOI: 10.1016/j.wem.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 09/28/2022] [Accepted: 11/03/2022] [Indexed: 01/30/2023]
Abstract
INTRODUCTION Little is known about the epidemiology of emergency medical search and rescue incidents globally. The purpose of this study was to describe the epidemiology of emergency medical search and rescue incidents in the North Shore Mountains of Vancouver, British Columbia, Canada. METHODS This was a retrospective review and descriptive analysis of search and rescue incident reports created by North Shore Rescue over a 25 y period from 1995 to 2019, inclusive. Incident reports were screened for inclusion against a priori criteria defining a medical callout. The National Advisory Committee of Aeronautics (NACA) severity score was used as a method to grade medical acuity of included subjects. RESULTS We included 906 subjects. Their median age was 35 y (interquartile range, 24-53), and 65% of subjects were men. Forty-one percent (n=371) of subjects were classified as non-trauma and 54% (n=489) as trauma. The top 3 activities were hiking (53%), biking (10%), and snow sports (10%). Forty-nine percent of incidents were classified as having a NACA score of ≥3. For subjects with trauma, the top 3 body regions were lower limb (52%), head (18%), and torso (12%). For subjects with non-traumatic conditions, the top 3 causes were mental health crises (25%), exposure (25%), and cardiovascular incidents (11%). CONCLUSIONS Half of the incidents were serious enough to require medical assessment at a hospital (NACA score ≥3). Given this medical acuity, there is a need for evidence-based guidelines and core training competencies for mountain medical search and rescue. Standardized core data sets and outcomes are needed to monitor quality of care over time.
Collapse
Affiliation(s)
- Dylan Collins
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Michael Crickmer
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kayla Brolly
- North Shore Rescue, North Vancouver, British Columbia, Canada
| | - Daniel Abrams
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alec Ritchie
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada; North Shore Rescue, North Vancouver, British Columbia, Canada
| | - William Milsom
- North Shore Rescue, North Vancouver, British Columbia, Canada; Department of Zoology, University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
11
|
Stress of emergency physicians during helicopter operations: impact of patients' diagnoses, severity of diagnoses, and physicians' work experience. BMC Emerg Med 2023; 23:20. [PMID: 36803306 PMCID: PMC9942287 DOI: 10.1186/s12873-023-00786-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 10/05/2022] [Indexed: 02/22/2023] Open
Abstract
PURPOSE Emergency physicians are in danger of developing illnesses due to stress in their demanding work environment. Until today, scholars have not identified stressors or resilience factors that qualify to promote the preservation of emergency physicians' well-being. Therefore, potential influencing variables such as patients' diagnoses, the severity of diagnoses, as well as physicians' work experience have to be considered. The present study aims at investigating emergency physicians in the Helicopter Emergency Medical Service (HEMS)' autonomic nervous system activity during emergency operations in one shift with respect to patients' diagnoses, severity of diagnoses, and physicians' work experience. METHODS Measurement of HRV (employing the parameters RMSSD and LF/HF) for 59 EPs (age: M = 39.69, SD = 6.19) was performed during two complete air-rescue-days, the alarm and landing phase being investigated in particular. Besides patients' diagnoses, the National Advisory Committee for Aeronautics Score (NACA) was included as an indicator for severity. Diagnoses' and NACA's effect on HRV were examined using a linear mixed model. RESULTS Both HRV parameters indicate a significant decrease of the parasympathetic nervous system as a function of the diagnoses. Furthermore, high NACA scores (≥ V) predicted a significantly lower HRV. In addition, a lower HRV/RMSSD with increasing work experience was observed as well as a positive association between physicians' work experience and sympathetic activation (LF/HF). CONCLUSION The present study showed that pediatric diagnoses as well as time-critical diagnoses are most stressful and have the highest impact on the physicians' ANS. This knowledge allows the development of specific training to reduce stress.
Collapse
|
12
|
Vuilleumier S, Spichiger T, Dénéréaz S, Fiorentino A. Not only COVID-19 disease impacts ambulance emergency demands but also lockdowns and quarantines. BMC Emerg Med 2023; 23:4. [PMID: 36635638 PMCID: PMC9836922 DOI: 10.1186/s12873-023-00772-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 01/02/2023] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND The pandemic has impacted both patients infected by the SARS-CoV-2 virus and patients who seek emergency assistance due to other health issues. Changes in emergency demands are expected to have occurred during the pandemic, the objective of this investigation is to characterize the changes in ambulance emergency demands during the first year of the COVID-19 pandemic in the Vaud State of Switzerland. The goal of this research is to identify the collateral effects of the COVID-19 pandemic on emergency demands. To do so, this study quantifies the differences in health issues, level of severity, and patients' sociodemographic characteristics (age, location, gender) prior to and during the outbreak. METHOD This is a retrospective, descriptive and comparative statistical analysis of all ambulance emergency missions from 2018 to 2020 (n = 107,150) in the State of Vaud in Switzerland. Variables analyzed were the number of ambulance missions, patient age and gender, health issues, severity (NACA scores), number of non-transports, mission times and locations. Variables were compared between prepandemic and pandemic situations across years and months. Comparative analysis used bivariate analysis, χ2 test, Student's t test, and Mann‒Whitney U test. RESULTS The pandemic has had two major impacts on the population's emergency demands. The first appears to be due to COVID-19, with an increase in respiratory distress cases that doubled in November 2020. The second relates to the implementation of lockdown and quarantine measures for the population and the closures of restaurants and bars. These might explain the decrease in both the number of traumas and intoxications, reaching more than 25% and 28%, respectively. An increase in prehospital emergency demands by the older population, which accounted for 53% of all demands in 2020, is measured. CONCLUSION Collateral effects occurred during 2020 and were not only due to the pandemic but also due to protective measures deployed relative to the population. This work suggests that more targeted reflections and interventions concerning the most vulnerable group, the population of people 65 and older, should be of high priority. Gaining generalizable knowledge from the COVID-19 pandemic in prehospital settings is critical for the management of future pandemics or other unexpected disasters.
Collapse
Affiliation(s)
- Séverine Vuilleumier
- La Source School of Nursing, University of Applied Sciences and Art Western Switzerland (HES-SO), Lausanne, CH-1004 Switzerland
| | - Thierry Spichiger
- grid.507562.3ES ASUR, Vocational Training College for Registered Paramedics and Emergency Care, Le Mont- sur-Lausanne, CH-1052 Switzerland
| | - Sandrine Dénéréaz
- grid.507562.3ES ASUR, Vocational Training College for Registered Paramedics and Emergency Care, Le Mont- sur-Lausanne, CH-1052 Switzerland
| | - Assunta Fiorentino
- La Source School of Nursing, University of Applied Sciences and Art Western Switzerland (HES-SO), Lausanne, CH-1004 Switzerland
| |
Collapse
|
13
|
Krammel M, Drahohs V, Hamp T, Lemoyne S, Grassmann D, Schreiber W, Sulzgruber P, Schnaubelt S. The Epidemiology of Pre-Hospital EMS Treatment of Geriatric Patients in the City of Vienna-An Overview. J Clin Med 2023; 12:jcm12020643. [PMID: 36675572 PMCID: PMC9865411 DOI: 10.3390/jcm12020643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/10/2023] [Accepted: 01/11/2023] [Indexed: 01/15/2023] Open
Abstract
Background: The city of Vienna, Austria, has a gradually aging population. Elderly people, over 65 years old and living at home or in nursing homes, frequently use Emergency Medical Services (EMS). However, there is no previous data comparing the EMS utilization of elderly- and non-elderly patients in Vienna. Methods: We retrospectively analyzed all EMS incidents in Vienna from 2012 to 2019. Transport- and emergency physician treatment rates, annual fluctuations, and the number of non-transports were compared between elderly (≥65 years) and non-elderly (18−64 years) patients. Results: Elderly people accounted for 42.6% of the total EMS responses in adult patients, representing an annual response rate of 223 per 1000 inhabitants ≥ 65 years. Compared to 76 per 1000 inhabitants in patients 18−64 years old, this results in an incidence rate ratio (IRR) of 2.93 [2.92−2.94]. Elderly people were more likely (OR 1.68 [1.65−1.70]) to need emergency physicians, compared to 18−64 year-olds. Nursing home residents were twice (OR 2.11 [2.06−2.17]) as likely to need emergency physicians than the rest of the study group. Non-transports were more likely to occur in patients over 65 years than in non-elderlies (14% vs. 12%, p < 0.001). Conclusions: The elderly population ≥ 65 years in Vienna shows higher EMS response rates than younger adults. They need emergency physicians more often, especially when residing in nursing homes. The economical and organizational strain this puts on the emergency response system should trigger further research and the development of solutions, such as specific response units dedicated to elderly people.
Collapse
Affiliation(s)
- Mario Krammel
- Austrian Cardiac Arrest Awareness Association (PULS), 1090 Vienna, Austria
- Emergency Medical Service, 1030 Vienna, Austria
| | - Valentin Drahohs
- Department of Anaesthesiology and Critical Care Medicine, Hospital St. Poelten, 3100 St. Poelten, Austria
| | - Thomas Hamp
- Emergency Medical Service, 1030 Vienna, Austria
- Department of Anaesthesiology, General Intensive Care Medicine, and Pain Therapy, Medical University of Vienna, 1090 Vienna, Austria
| | - Sabine Lemoyne
- Department of Emergency Medicine, Antwerp University Hospital, 2650 Edegem, Belgium
| | - Daniel Grassmann
- Austrian Cardiac Arrest Awareness Association (PULS), 1090 Vienna, Austria
- Emergency Medical Service, 1030 Vienna, Austria
| | - Wolfgang Schreiber
- Austrian Cardiac Arrest Awareness Association (PULS), 1090 Vienna, Austria
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria
| | - Patrick Sulzgruber
- Austrian Cardiac Arrest Awareness Association (PULS), 1090 Vienna, Austria
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria
| | - Sebastian Schnaubelt
- Austrian Cardiac Arrest Awareness Association (PULS), 1090 Vienna, Austria
- Department of Emergency Medicine, Antwerp University Hospital, 2650 Edegem, Belgium
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria
- Correspondence:
| |
Collapse
|
14
|
Gasser B. Deathly Accidents While High-Altitude Mountaineering in the Swiss Alps-An Observational Analysis from 2009 to 2021. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12498. [PMID: 36231795 PMCID: PMC9566316 DOI: 10.3390/ijerph191912498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 09/22/2022] [Accepted: 09/28/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND High-altitude mountaineering has become more and more popular. While many enjoy the beauty of the highest parts of Switzerland, there are considerable risks, which can even result in death. This study analyzed fatal events while high-altitude mountaineering in the Swiss Alps. MATERIALS AND METHODS In this study, cases of emergencies while high-altitude mountaineering in the Swiss Alps were analyzed in the period from 2009 to 2021 from the Swiss Alpine Club (SAC) emergency registry. Fatal emergencies were identified and analyzed in detail. RESULTS In total, 5020 emergency cases were analyzed, and among them 303 deathly events where detected. Of the fatal emergencies, 261 cases (86.1%) were male and 42 (13.9%) were female. The average age was 53.2 ± 19.1 years. More than half of the emergencies were on a route to a classic four-thousander. Fatal events were most common on the Matterhorn, with 40 cases (13.2%); on the Mönch, with 18 cases (5.9%); and on the Piz Bernina, with 10 cases (3.3%). In 245 of the fatal emergencies (80.9%), a fall was the cause. The second most prominent cause was rockfalls, with 16 cases (5.3%), followed by stranding, with 10 cases (3.3%), and avalanches, with 9 cases (3%). Illnesses and crevasse accidents counted together for less than 5% of the fatal cases. Almost two-thirds of fatal falls occurred while descending. Concerning nationality, 30% were from Switzerland and more than three-fourths of victims were from the countries of the Alps. DISCUSSION We found that falls were the most common cause of fatal emergencies in the Swiss Alps. Concerning the fact that most of these emergencies occurred during descents, fatigue and inadequate focus (forgetting the risks of the descent after successfully reaching the peak) are potential reasons for the fatal events. This potentially resulted from a lack of acclimatization, insufficient physical fitness, and inadequate tour planning. Since most victims were from the countries of the Alps, training tours may be possible as a recommended preparation for more difficult four-thousander peaks.
Collapse
Affiliation(s)
- Benedikt Gasser
- Departement für Sport, Bewegung und Gesundheit-Abteilung Rehabilitative und Regenerative Sportmedizin-Universität Basel-Grosse Allee 6, CH-4052 Basel, Switzerland
| |
Collapse
|
15
|
Ulvin OE, Skjærseth EÅ, Haugland H, Thorsen K, Nordseth T, Orre MF, Vesterhus L, Krüger AJ. The introduction of a regional Norwegian HEMS coordinator: an assessment of the effects on response times, geographical service areas and severity scores. BMC Health Serv Res 2022; 22:1020. [PMID: 35948977 PMCID: PMC9365225 DOI: 10.1186/s12913-022-08337-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 07/12/2022] [Indexed: 11/24/2022] Open
Abstract
Background Due to unwanted delays and suboptimal resource control of helicopter emergency medical services (HEMS), regional HEMS coordinators have recently been introduced in Norway. This may represent an unnecessary link in the alarm chain, which could cause delays in HEMS dispatch. Systematic evaluations of this intervention are lacking. We wanted to conduct this study to assess possible changes in HEMS response times, mission distribution patterns and patient characteristics within our region following this intervention. Methods We retrospectively collected timeline parameters, patient characteristics and GPS positions from HEMS missions executed by three regional HEMS bases in Mid-Norway during 2017–2018 (preintervention) and 2019 (postintervention). The mean regional response time in HEMS missions was assessed by an interrupted time series analysis (ITS). The geographical mission distribution between regional HEMS resources was assessed by a before-after study with a convex hull-based method. Results There was no significant change in the level (-0.13 min/month, p = 0.88) or slope (-0.13 min/month, p = 0.30) of the mean regional response time trend line pre- and postintervention. For one HEMS base, the service area was increased, and the median mission distance was significantly longer. For the two other bases, the service areas were reduced. Both the mean NACA score (4.13 ± SD 0.027 vs 3.98 ± SD 0.04, p < 0.01) and the proportion of patients with severe illness or injury (NACA 4–7, 68.2% vs 61.5%, p < 0.001) were higher in the postintervention group. Conclusion The introduction of a regional HEMS coordinator in Mid-Norway did not cause prolonged response times in acute HEMS missions during the first year after implementation. Higher NACA scores in the patients treated postintervention suggest better selection of HEMS use.
Collapse
Affiliation(s)
- Ole Erik Ulvin
- Department of Research, Norwegian Air Ambulance Foundation, Oslo, Norway. .,Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway. .,Department of Emergency Medicine and Pre-Hospital Services, St. Olav`s University Hospital, Trondheim, Norway. .,Department of Anaesthesia and Intensive Care Medicine, St. Olav`s University Hospital, Trondheim, Norway.
| | - Eivinn Årdal Skjærseth
- Department of Emergency Medicine and Pre-Hospital Services, St. Olav`s University Hospital, Trondheim, Norway
| | - Helge Haugland
- Department of Emergency Medicine and Pre-Hospital Services, St. Olav`s University Hospital, Trondheim, Norway.,Department of Anaesthesia and Intensive Care Medicine, St. Olav`s University Hospital, Trondheim, Norway
| | - Kjetil Thorsen
- Department of Research, Norwegian Air Ambulance Foundation, Oslo, Norway
| | - Trond Nordseth
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Department of Anaesthesia and Intensive Care Medicine, St. Olav`s University Hospital, Trondheim, Norway.,Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| | - Marie Falch Orre
- Department of Civil and Environmental Engineering, Master's Degree Programme of Engineering and ICT, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Lars Vesterhus
- Department of Emergency Medicine and Pre-Hospital Services, St. Olav`s University Hospital, Trondheim, Norway
| | - Andreas Jørstad Krüger
- Department of Research, Norwegian Air Ambulance Foundation, Oslo, Norway.,Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Department of Emergency Medicine and Pre-Hospital Services, St. Olav`s University Hospital, Trondheim, Norway
| |
Collapse
|
16
|
Stranded because of exhaustion while high-altitude mountaineering in the Swiss Alps: a retrospective nationwide study. Sci Rep 2022; 12:9011. [PMID: 35637240 PMCID: PMC9151813 DOI: 10.1038/s41598-022-12917-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 05/18/2022] [Indexed: 11/29/2022] Open
Abstract
Fortunately, fatal accidents while high-altitude mountaineering have decreased in recent years, but the number of emergencies has increased. These nonfatal emergencies might represent situations where alpinists are stranded (emergencies in which alpinists are no longer able to continue their tour on their own because of, for example, exhaustion, equipment problems, or weather). We analyzed 4596 cases of high-altitude-mountaineering emergencies in the period 2009 to 2020 from the SAC (Swiss Alpine Club) emergency registry. In total, 1951 cases (41.6%) were due to being stranded, 1348 cases were due to falls (28.7%), and 352 cases were due to illness (7.5%); these were the three most common classes. In cases of being stranded, 90% of alpinists were uninjured or not seriously injured. In addition, we found only eight fatal cases. More than 50% of cases occurred while ascending a summit above 4000 m. The main causes of becoming stranded were exhaustion and weather changes. These findings suggest that alpinists contact rescue organizations before experiencing serious troubles; these situations thus present risks and dangers both to those stranded and to emergency services. Since exhaustion and weather changes are the two main causes, adequate preparation and tour planning may help prevent such emergencies.
Collapse
|
17
|
Cases of Lightning Strikes during Mountain-Sports Activities: An Analysis of Emergencies from the Swiss Alps. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19073954. [PMID: 35409637 PMCID: PMC8998020 DOI: 10.3390/ijerph19073954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/21/2022] [Accepted: 03/22/2022] [Indexed: 02/01/2023]
Abstract
Background: Lightning strikes are a risk during mountain-sport activities. Yet little is known about the prevalence of injuries related to lightning strikes during mountain hiking, backcountry skiing, or high-altitude mountaineering. This study therefore examined the occurrence and characteristics of lightning-strike-related emergencies during mountain-sport activities in the Swiss Alps. Methods: We analyzed 11,221 alpine emergencies during mountain hiking, 4687 during high-altitude mountaineering, and 3044 during backcountry skiing in the observational period from 2009 to 2020. Identified cases were analyzed in detail regarding age, sex, the time of occurrence, altitude, location, the severity of the injury as quantified by its NACA Score (National Advisory Committee for Aeronautics Score), and injury pattern. Results: We found no cases related to backcountry skiing. Eight cases of lightning strikes during mountain hiking (four female and four male) were identified. The mean age was 32.5 ± 17.5 years, the mean NACA Score was 2.5 ± 1.9, and the mean altitude was 1883.8 ± 425.7 m. None of these cases were fatal, and only one victim was seriously injured. Fifteen cases were identified during high-altitude mountaineering (four female and 11 male). The mean age was 38.7 ± 5.2 years, the mean NACA Score was 3.1 ± 2.5, and the mean altitude was 3486.4 ± 614.3 m. Two lightning strikes were fatal. In these two cases, rope partners were injured by a lightning strike (NACA Score = 4). Most cases were on relatively exposed terrain, such as the Matterhorn Hörnligrat or the Eiger Mittellegigrat. Discussion: The typical victims were 30–40-year-old men. It is possible that the lightning strikes are a consequence of a lower risk aversion among these alpinists, which is be supported by the fact that most of the events occurred on famous mountains such as the Matterhorn or Eiger. Furthermore, since most of the locations were on relatively exposed terrain where one could not quickly find shelter, we recommend careful tour planning with serious consultation of the weather forecast and the likelihood of thunderstorms before climbing exposed sections to prevent emergencies related to lightning strikes.
Collapse
|
18
|
Gasser BA, Schwendinger F. Has Being Lost While High-Altitude Mountaineering Become Less Frequent? A Retrospective Analysis from the Swiss Alps. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:1844. [PMID: 35162867 PMCID: PMC8834690 DOI: 10.3390/ijerph19031844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 01/11/2022] [Accepted: 01/19/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND High-altitude mountaineering is becoming more popular. Despite technical developments such as global positioning systems, mountaineers still lose their way. This study aimed to analyze characteristics of alpinists that lost their way while high-altitude mountaineering in Switzerland. MATERIAL AND METHODS Data from the central registry of the Swiss Alpine Club between 2009 and 2020 were retrospectively analyzed. Changes in the number of cases and severity of injuries over time were examined using simple linear regression models. Descriptive analyses were performed for age, time of emergency occurrence, and factors associated with being lost. The Mann-Whitney U test assessed between-sex comparisons. RESULTS Of the 4596 emergency cases during the observation period, 275 cases (5.9%) were due to being lost (76.4% male). A mean of 22.9 ± 9.6 cases per year was detected. The number of cases did not change significantly over time. Similarly, this was the case for the NACA-Score (National Advisory Committee for Aeronautics Score) with the majority of mountaineers remaining uninjured (77.8%). The median age was 42 (35-54) years for the full sample and 45 (35-56) years and 40 (33-48) years for males and females, respectively. Fog or weather changes, exhaustion, and inadequate tour planning (time and darkness) were frequently documented by rescuers as perceived reasons for being lost. Regarding the time of emergency occurrence, three peaks were detected, around 10 am, 5 pm, and 8 pm. CONCLUSIONS Our findings show that the number of emergencies due to being lost was stable during the 12-year period. Furthermore, we presented factors that might be associated with losing one's way during mountaineering. These results may form an important basis for future studies determining risk factors for being lost and the prevention of such emergencies.
Collapse
|
19
|
Gasser B, Stouder J. Rescue Emergencies Due to High-Altitude Illnesses Are Rare in Switzerland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19020865. [PMID: 35055685 PMCID: PMC8776185 DOI: 10.3390/ijerph19020865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 12/31/2021] [Accepted: 01/10/2022] [Indexed: 02/04/2023]
Abstract
Background: Despite a potential high risk of acute mountain sickness (AMS) in the Swiss Alps, there is a lack of analyses concerning its relevance over longer periods. In consequence, the aim of this study is to analyze the prevalence of AMS in comparison to other causes of mountain emergencies in recent years in Switzerland. Material and Methods: Based on the central registry of mountain emergencies of the Swiss Alpine Club (SAC), all cases in the period between 2009 and 2020 were analyzed for AMS including the most severe forms of high-altitude pulmonary edema (HAPE) and high-altitude cerebral edema (HACE). Emergencies were assessed for the severity of the event with a National Advisory Committee for Aeronautics (NACA) score. Results: From a total of 4596 high-altitude mountaineering emergencies identified in the observational period, a total number of 352 cases of illnesses were detected. Detailed analysis revealed 85 cases of AMS, 5 cases of HAPE, and 1 case of HACE. The average altitude was 3845 ± 540 m. Most cases were in the canton of Valais, especially in the Monte Rosa region and the mountains of the Mischabel group (Täschhorn, Dom, Südlenz, Nadelhorn, Hohberghorn). There were only three deaths related to high-altitude illnesses; all the other events could be identified as moderate to severe but not life-threatening. Discussion: An emergency due to AMS that requires rescue is unlikely in the Swiss Alps. This does not imply that AMS is not a concern. However, the facts that the maximal altitude is relatively low and that fast self-descents often seem possible probably minimize the likelihood that mountaineers with symptoms contact emergency services.
Collapse
|
20
|
Adam SB, Alstrup K, Rognås L. Secondary Transfers to University Hospitals in Patients Primarily Triaged to District General Hospitals by the Danish Helicopter Emergency Medical Service: A National Population-Based Study. Air Med J 2022; 41:57-62. [PMID: 35248344 DOI: 10.1016/j.amj.2021.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 08/20/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to analyze data from the Danish helicopter emergency medical service (HEMS) database, focusing on patients undergoing a secondary transfer from district general hospitals (DGHs) to university hospitals within 24 hours of the initial emergency call. METHODS This is a national population-based study analyzing HEMS patients undergoing a secondary transfer between October 1, 2014, and April 30, 2018. RESULTS Fifty-three (2.9%) of the 1,846 patients initially triaged to a DGH by the HEMS team required a secondary transfer. These 53 patients constituted 0.7% of all 7,133 patients seen by the HEMS teams during the study period. More than 60% of these patients were initially treated for either a cardiovascular or a neurologic emergency. HEMS-escorted patients had a mortality rate at day 30 of 14.3% (95% confidence interval, 4.8-38.0), and the HEMS-assisted group had a mortality rate at day 30 of 3.1% (95% CI, 0.5-20.2). CONCLUSION Patients initially triaged to a DGH by the HEMS teams seldomly required a secondary transfer, indicating a low degree of prehospital undertriage for direct transfer to a university hospital. Cardiovascular or neurologic emergencies were the major reasons for transportation. Mortality seems comparable with that in the general population of patients treated by the Danish HEMS teams.
Collapse
Affiliation(s)
- Sidsel Bjørgo Adam
- Department of Research and Development, Pre-hospital Emergency Medical Services, Central Denmark Region, Aarhus, Denmark
| | - Karen Alstrup
- Department of Research and Development, Pre-hospital Emergency Medical Services, Central Denmark Region, Aarhus, Denmark.
| | - Leif Rognås
- Department of Research and Development, Pre-hospital Emergency Medical Services, Central Denmark Region, Aarhus, Denmark; Department of Anaesthesiology, Aarhus University Hospital, Aarhus, Denmark; The Danish Air Ambulance, Aarhus, Denmark
| |
Collapse
|
21
|
Thorley L, Shepherd B, Donohue A, MacKillop A. Profiling helicopter emergency medical service winch operations involving physicians in Queensland, Australia. Emerg Med Australas 2021; 34:355-360. [PMID: 34719134 DOI: 10.1111/1742-6723.13892] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 09/28/2021] [Accepted: 10/15/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To analyse the mission profiles of helicopter emergency medical service (HEMS) winch operations involving LifeFlight Retrieval Medicine physicians in Queensland, Australia, specifically focusing on patients' clinical characteristics, extrication methods and scene times. METHODS A retrospective analysis was performed to identify all helicopter winch missions involving physicians during 2019. Demographic, clinical and non-clinical data were accessed from an electronic database used to log cases and findings presented using descriptive statistics. RESULTS Out of 4356 HEMS missions involving physicians, 100 (2.3%) were winch operations. Of these, 31 (31%) occurred overwater and 12 (12%) at night. In total, 106 patients were attended, and eight patient deaths occurred. Most patients were traumatically injured (66%), male (66%) and had a median (interquartile range) age of 43.5 (28-59) years. Thirteen missions (13%) involved drowning victims. This group had a higher burden of injury and comprised half of the patients treated with endotracheal intubation. Median scene time was 30 min (20-40), and the winch stretcher was the predominant patient extrication method. Physician winching occurred in 63 (63%) missions and was associated with increased scene time and increased use of the winch stretcher. CONCLUSIONS Winch operations involving physicians occur infrequently in Queensland HEMS, although almost a third of missions occur overwater. Drowning victims are encountered more frequently than reported elsewhere in Australian HEMS and comprised half of the patients who underwent endotracheal intubation. Patients' severity of illness and injury may contribute to the associations between winching of physicians, increased scene times and increased use of the winch stretcher.
Collapse
Affiliation(s)
- Liam Thorley
- Emergency Services Division, Royal Flying Doctor Service of Australia (South Eastern Section), Dubbo, New South Wales, Australia
| | - Ben Shepherd
- Department of Clinical Operations, LifeFlight Retrieval Medicine, Mackay, Queensland, Australia.,Emergency Department, Mackay Base Hospital, Mackay, Queensland, Australia
| | - Andrew Donohue
- Department of Clinical Operations, LifeFlight Retrieval Medicine, Mackay, Queensland, Australia.,Anaesthetic Department, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Allan MacKillop
- Department of Clinical Operations, LifeFlight Retrieval Medicine, Mackay, Queensland, Australia
| |
Collapse
|
22
|
Møller TP, Ersbøll AK, Kjærulff TM, Bihrmann K, Alstrup K, Knudsen L, Hansen TM, Berlac PA, Lippert F, Barfod C. Helicopter emergency medical services missions to islands and the mainland during a 3-year period in Denmark: a population-based study on patient and sociodemographic characteristics, comorbidity, and use of healthcare services. Scand J Trauma Resusc Emerg Med 2021; 29:152. [PMID: 34663396 PMCID: PMC8522108 DOI: 10.1186/s13049-021-00963-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 09/30/2021] [Indexed: 11/12/2022] Open
Abstract
Background The Danish Helicopter Emergency Medical Services (HEMS) is part of the Danish Emergency Medical Services System serving 5.7 million citizens with 1% living on islands not connected to the mainland by road. HEMS is dispatched based on pre-defined criteria including severity and urgency, and moreover to islands for less urgent cases, when rapid transport to further care is needed. The study aim was to characterize patient and sociodemographic factors, comorbidity and use of healthcare services for patients with HEMS missions to islands versus mainland. Methods Descriptive study of data from the HEMS database in a three-year period from 1 October 2014 to 30 September 2017. All missions in which a patient was either treated on scene or transported by HEMS were included. Results Of 5776 included HEMS missions, 1023 (17.7%) were island missions. In total, 90.2% of island missions resulted in patient transport by HEMS compared with 62.1% of missions to the mainland. Disease severity was serious or life-threatening in 34.7% of missions to islands compared with 65.1% of missions to mainland and less interventions were performed by HEMS on island missions. The disease pattern differed with more “Other diseases” registered on islands compared with the mainland where cardiovascular diseases and trauma were the leading causes of contact. Patients from islands were older than patients from the mainland. Sociodemographic characteristics varied between inhabiting island patients and mainland patients: more island patients lived alone, less were employed, more were retired, and more had low income. In addition, residing island patients had to a higher extend severe comorbidity and more contacts to general practitioners and hospitals compared with the mainland patients. Conclusions HEMS missions to islands count for 17.7% of HEMS missions and 90.2% of island missions result in patient transport. The island patients encountered by HEMS are less severely diseased or injured and interventions are less frequently performed. Residing island patients are older than mainland patients and have lower socioeconomic position, more comorbidities and a higher use of health care services. Whether these socio-economic differences result in longer hospital stay or higher mortality is still to be investigated. Supplementary Information The online version contains supplementary material available at 10.1186/s13049-021-00963-6.
Collapse
Affiliation(s)
- Thea Palsgaard Møller
- Copenhagen Emergency Medical Services and University of Copenhagen, Copenhagen, Denmark.
| | - Annette Kjær Ersbøll
- National Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | | | - Kristine Bihrmann
- National Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Karen Alstrup
- Department of Research and Development, Pre-Hospital Emergency Medical Services, Central Denmark Region, Aarhus, Denmark
| | - Lars Knudsen
- Department of Anesthesiology, Aarhus University Hospital, Aarhus, Denmark.,The Danish Air Ambulance, Aarhus, Denmark
| | | | - Peter Anthony Berlac
- Copenhagen Emergency Medical Services and University of Copenhagen, Copenhagen, Denmark
| | - Freddy Lippert
- Copenhagen Emergency Medical Services and University of Copenhagen, Copenhagen, Denmark
| | - Charlotte Barfod
- Copenhagen Emergency Medical Services and University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
23
|
Sørensen LM, Rognås L, Alstrup K. Trauma Versus Nontrauma Patients Treated by the Danish Helicopter Emergency Medical Service: A Register-Based Study of Patient Characteristics, Hospitalization, and Mortality. Air Med J 2021; 40:325-330. [PMID: 34535240 DOI: 10.1016/j.amj.2021.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/31/2021] [Accepted: 05/12/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Helicopter emergency medical services (HEMS) are part of many emergency health care systems, ensuring specialized treatment on scene. An accurate use is important for improved resource utilization. The aim of this study was to describe patient characteristics, hospitalization, and mortality in trauma and nontrauma patients seen by the Danish HEMS teams. METHODS The study is a registry-based study presenting data from the national Danish HEMS database. We included all HEMS missions from October 1, 2014, to April 30, 2018. RESULTS A total of 13,391 HEMS entries were registered, and 5,524 cases were included in the study. Trauma patients were younger (38 vs. 63 years) and had a lower level of comorbidities (Charlson Comorbidity Index 0: 82% vs. 58%) compared with nontrauma patients. More nontrauma cases were classified with a severity score corresponding to a critical emergency. They also had a higher 30-day mortality compared with trauma patients (26% vs. 11%). CONCLUSION This national study demonstrated differences in demographics, the severity profile, and mortality among trauma compared with nontrauma patients that could possibly indicate an overuse of HEMS for minor trauma cases. The results might suggest that educational efforts and a review of the current dispatch guidelines could be of importance when trying to improve the use of HEMS.
Collapse
Affiliation(s)
- Louise Marqvard Sørensen
- Department of Research and Development, Pre-hospital Emergency Medical Services, Central Denmark Region, Aarhus, Denmark
| | - Leif Rognås
- Department of Research and Development, Pre-hospital Emergency Medical Services, Central Denmark Region, Aarhus, Denmark; Department of Anaesthesiology, Aarhus University Hospital, Aarhus, Denmark; The Danish Air Ambulance, Aarhus, Denmark
| | - Karen Alstrup
- Department of Research and Development, Pre-hospital Emergency Medical Services, Central Denmark Region, Aarhus, Denmark.
| |
Collapse
|
24
|
Medizinische Ereignisse auf Windenergieanlagen offshore – retrospektive Analyse der Behandlungsdaten 2017–2020. Notf Rett Med 2021. [DOI: 10.1007/s10049-021-00938-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Zusammenfassung
Hintergrund
Insgesamt arbeiten täglich mehrere Tausend Menschen im Offshore-Bereich. Die Arbeit findet regelhaft unter beengten Bedingungen, in Höhen und Tiefen statt, woraus ein erhöhtes Gefahrenpotenzial mit spezifischen Verletzungen resultiert. Weiterhin müssen die Arbeiter in ihren mehrwöchigen Einsätzen allgemeinmedizinisch versorgt werden. Nach erfolgter Digitalisierung der medizinischen Einsatzdokumentation sollen nun die ersten Jahre ausgewertet und vor allem Art und Inzidenz der Notfälle analysiert werden.
Methode
4356 Datensätze aus dem Zeitraum Juni 2017 bis Dezember 2020 wurden im Rahmen der Versorgung und Einsatzdokumentation durch das eingesetzte Rettungsfachpersonal mittels digitalem Protokoll erfasst und nun anonymisiert retrospektiv ausgewertet.
Ergebnisse
Bei den definierten Diagnosegruppen waren am häufigsten die Infektionen (13,2 %) und Atemwegserkrankungen (8,4 %) sowie bei den Unfällen die Traumata der oberen (8,4 %) und unteren (4,6 %) Extremität. Entsprechend zählten 21,2 % der Einsätze zu den traumatologischen Notfällen, 71,1 % zu internistischen und 4,0 % zu sonstigen Erkrankungen. Die meisten Fälle wurden als geringfügige (61,2 %) oder ambulant behandelbare Störungen (23,4 %) eingestuft. Der nur bei vollständigen Datensätzen (n = 884) zu errechnende Schweregrad (Mainz Emergency Evaluation Score) lag im Mittel bei 24,1 ± 2,2 von 28 Punkten. Nur 1,9 % der Patienten wurden per Offshore-Rettungshubschrauber an Land verlegt, 4,0 % konnten mittels „crew transfer vessel“ transportiert werden.
Schlussfolgerung
Bei den meisten medizinischen Notfällen handelte es sich um minderschwere Ereignisse aus dem internistischen Spektrum mit geringfügiger Störung und ambulanter Behandlung. Bei den traumatologischen Notfällen sind Verletzungen an den Extremitäten führend. War eine Landverlegung erforderlich, geschah diese meist mittels „crew transfer vessel“ und nur zu einem Viertel der Fälle via Offshore-Rettungshubschrauber. Auch hier überwogen internistische Erkrankungen als Transportindikation.
Collapse
|
25
|
Pietsch U, Knapp J, Mann M, Meuli L, Lischke V, Tissi M, Sollid S, Rauch S, Wenzel V, Becker S, Albrecht R. Incidence and challenges of helicopter emergency medical service (HEMS) rescue missions with helicopter hoist operations: analysis of 11,228 daytime and nighttime missions in Switzerland. Scand J Trauma Resusc Emerg Med 2021; 29:92. [PMID: 34253244 PMCID: PMC8276414 DOI: 10.1186/s13049-021-00898-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 06/09/2021] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE We aimed to investigate the medical characteristics of helicopter hoist operations (HHO) in HEMS missions. METHODS We designed a retrospective study evaluating all HHO and other human external cargo (HEC) missions performed by Swiss Air-Rescue (Rega) between January 1, 2010, and December 31, 2019. RESULTS During the study period, 9,963 (88.7 %) HEMS missions with HHO and HEC were conducted during the day, and 1,265 (11.3 %) at night. Of the victims with time-critical injuries (NACA ≥ 4), 21.1 % (n = 400) reached the hospital within 60 min during the day, and 9.1 % (n = 18) at night. Nighttime missions, a trauma diagnosis, intubation on-site, and NACA Score ≥ 4 were independently and highly significantly associated with longer mission times (p < 0.001). The greatest proportion of patients who needed hoist or HEC operations in the course of the HEMS mission during the daytime sustained moderate injuries (NACA 3, n = 3,731, 37.5 %) while practicing recreational activities (n = 5,492, 55.1 %). In daytime HHO missions, the most common medical interventions performed were insertion of a peripheral intravenous access (n = 3,857, 38.7 %) and administration of analgesia (n = 3,121, 31.3 %). CONCLUSIONS Nearly 20 % of patients who needed to be evacuated by a hoist were severely injured, and complex and lifesaving medical interventions were necessary before the HHO procedure. Therefore, only adequately trained and experienced medical crew members should accompany HHO missions.
Collapse
Affiliation(s)
- Urs Pietsch
- Department of Anaesthesiology and Intensive Care Medicine, Cantonal Hospital St. Gallen, Rorschacher Strasse 95, 9007, St. Gallen, Switzerland. .,Air Zermatt, Emergency Medical Service, 3920, Zermatt, Switzerland. .,Department of Emergency Medicine, Inselspital, Bern University, Bern, Switzerland. .,Swiss Air-Ambulance, Rega (Rettungsflugwacht/Guarde Aérienne), Zurich, Switzerland.
| | - Jürgen Knapp
- Air Zermatt, Emergency Medical Service, 3920, Zermatt, Switzerland.,Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland
| | - Michael Mann
- Air Zermatt, Emergency Medical Service, 3920, Zermatt, Switzerland
| | - Lorenz Meuli
- Department of Vascular Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Volker Lischke
- Air Zermatt, Emergency Medical Service, 3920, Zermatt, Switzerland
| | - Mario Tissi
- Swiss Air-Ambulance, Rega (Rettungsflugwacht/Guarde Aérienne), Zurich, Switzerland
| | - Stephen Sollid
- Norwegian Air Ambulance Foundation, PB 414 Sentrum, 0103, Oslo, Norway.,University of Stavanger, PB 8600 Forus, 4036, Stavanger, Norway
| | - Simon Rauch
- Institute of Mountain Emergency Medicine, Eurac Research, Bozen, Italy.,Department of Anaesthesiology and Intensive Care Medicine, F. Tappeiner Hospital, Merano, Italy
| | - Volker Wenzel
- Klinik für Anästhesie Klinikum Friedrichshafen GmbH, Röntgenstraße 2, 88048, Friedrichshafen, Germany
| | - Stefan Becker
- Swiss Air-Ambulance, Rega (Rettungsflugwacht/Guarde Aérienne), Zurich, Switzerland
| | - Roland Albrecht
- Department of Anaesthesiology and Intensive Care Medicine, Cantonal Hospital St. Gallen, Rorschacher Strasse 95, 9007, St. Gallen, Switzerland.,Swiss Air-Ambulance, Rega (Rettungsflugwacht/Guarde Aérienne), Zurich, Switzerland
| |
Collapse
|
26
|
Vuilleumier S, Fiorentino A, Dénéréaz S, Spichiger T. Identification of new demands regarding prehospital care based on 35,188 missions in 2018. BMC Emerg Med 2021; 21:63. [PMID: 34030660 PMCID: PMC8142491 DOI: 10.1186/s12873-021-00456-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 05/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Population ageing and increased prevalence of chronic diseases result in the emergence of new demands in prehospital care. The prehospital system is facing an increase of cases without acute threat to life (so-called "non-urgent"), which generates tension due to a higher number of admissions to emergency departments and a greater use of prehospital resources. Our aim is to understand this transition in prehospital activities and to delineate the primary missions performed by paramedics in 2018 with a focus on the population concerned, the severity of cases encountered and the typology of health issues. METHOD The study is retrospective, and descriptive, using a statistical description of 35,188 primary missions realized in 2018 in the State of Vaud (Switzerland). The characteristics taken into consideration are the age and gender of patients, as well as the health issue, the severity of cases based on National Advisory Committee for Aeronautics score (NACA score), and the time and place of intervention. RESULTS The results describe the primary missions in the State of Vaud in 2018 and show that 87% of missions concern "non-urgent" situations (without acute threat to life). Over half of patients are 65 or older, the highest proportion of health issues, 49%, are medical and only 23% of missions are for traumas. Mission related to mental health issues reach 7% and those for intoxication 6%. Most missions take place between 7:00 am and 6:00 pm (67%), and around 12% of missions lead to the non-transport of the patient. CONCLUSION The prehospital sector is confronted with a major transition in terms of patient care. An increase of non-urgent cases is observed, associated with the care of persons aged 65 or more. Our results question the adequacy between the needs in terms of prehospital care and the paramedic profession as it is currently defined, as well as the place of this profession within the health network. Reflecting upon the role of paramedics with respect to the socio-demographic evolution of populations appears necessary, to analyse the adequacy of the paramedics' skills to respond to the current needs.
Collapse
Affiliation(s)
- Séverine Vuilleumier
- La Source School of Nursing, University of Applied Sciences and Arts Western Switzerland (HES-SO), CH-1004, Lausanne, Switzerland.
| | - Assunta Fiorentino
- La Source School of Nursing, University of Applied Sciences and Arts Western Switzerland (HES-SO), CH-1004, Lausanne, Switzerland
| | - Sandrine Dénéréaz
- Vocational Training College for Registered Paramedics and Emergency Care, ES ASUR, CH-1052, Le Mont-sur-Lausanne, Switzerland
| | - Thierry Spichiger
- Vocational Training College for Registered Paramedics and Emergency Care, ES ASUR, CH-1052, Le Mont-sur-Lausanne, Switzerland
| |
Collapse
|
27
|
Mikkelsen VS, Gregers MCT, Justesen US, Schierbeck J, Mikkelsen S. Pre-hospital antibiotic therapy preceded by blood cultures in a physician-manned mobile emergency care unit. Acta Anaesthesiol Scand 2021; 65:540-548. [PMID: 33405246 DOI: 10.1111/aas.13777] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 11/20/2020] [Accepted: 12/28/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Rapid recognition and antibiotic treatment, preferably preceded by blood cultures (BCs), is a mainstay in sepsis therapy. The objective of this investigation was to determine if pre-hospital BCs were feasible and drawn with an acceptably low level of contamination and to investigate whether pre-hospital antibiotics were administered on correct indications. METHODS We performed a register-based study in a pre-hospital physician-manned mobile emergency care unit (MECU) operating in a mixed urban/rural area in Denmark. All patients who received pre-hospital antibiotics by the MECU from November 2013 to October 2018 were reviewed. Outcome measures were characterisation of microbial findings and subsequent in-hospital confirmation of the pre-hospital indication for antibiotics. RESULTS One-hundred-and-nineteen patients received antibiotics pre-hospitally. Six were excluded. One-hundred-and-thirteen patients were included in the study. BCs were drawn in 107 of the 113 patients (94.7% [88.8%-98.0%]). We found a true pathogen of sepsis in 29 (27.1% [19.0%-36.6%]) of these 107 patients. Nine (8.4% [3.9%-15.4%]) patients had contaminated pre-hospital BCs. Forty-nine of all patients (36.3% [27.4%-45.9%]) had causative pathogens in either their BCs or other samples confirming the pre-hospital tentative diagnosis. Eighty-two (72.6% [63.4%-80.5%]) patients received antibiotic therapy in-hospitally, while 27 (23.9% [16.4%-32.8%]) were assigned an in-hospital diagnosis not associated with infection. Four (3.5% [1.0%-8.8%]) patients died in hospital before a diagnosis was established. CONCLUSIONS Pre-hospital administration of antibiotics preceded by BCs is feasible, although with somewhat high blood culture contamination rates. Antibiotics are administered on reasonable indications.
Collapse
Affiliation(s)
- Vibe S Mikkelsen
- Mobile Emergency Care Unit in Odense, Department of Anaesthesiology and Intensive Care Medicine, Odense, Denmark
- OPEN Open Patient Data Explorative Network, Department of Clinical Research, University of Southern, Odense, Denmark
| | - Mads Christian Tofte Gregers
- Mobile Emergency Care Unit in Odense, Department of Anaesthesiology and Intensive Care Medicine, Odense, Denmark
| | - Ulrik Stenz Justesen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Clinical Microbiology, Odense University Hospital, Odense, Denmark
| | - Jens Schierbeck
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Anaesthesiology and Intensive Care Medicine, Odense University Hospital, Odense, Denmark
| | - Søren Mikkelsen
- Mobile Emergency Care Unit in Odense, Department of Anaesthesiology and Intensive Care Medicine, Odense, Denmark
- OPEN Open Patient Data Explorative Network, Department of Clinical Research, University of Southern, Odense, Denmark
- Department of Anaesthesiology and Intensive Care Medicine, Odense University Hospital, Odense, Denmark
- Prehospital Research Unit, Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
28
|
Chappuis VN, Deham H, Cottet P, Gartner BA, Sarasin FP, Niquille M, Suppan L, Larribau R. Emergency physician's dispatch by a paramedic-staffed emergency medical communication centre: sensitivity, specificity and search for a reference standard. Scand J Trauma Resusc Emerg Med 2021; 29:31. [PMID: 33563301 PMCID: PMC7871575 DOI: 10.1186/s13049-021-00844-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 01/29/2021] [Indexed: 12/14/2022] Open
Abstract
Background Some emergency medical systems (EMS) use a dispatch centre where nurses or paramedics assess emergency calls and dispatch ambulances. Paramedics may also provide the first tier of care “in the field”, with the second tier being an Emergency Physician (EP). In these systems, the appropriateness of the decision to dispatch an EP to the first line at the same time as the ambulance has not often been measured. The main objective of this study was to compare dispatching an EP as part of the first line emergency service with the severity of the patient’s condition. The secondary objective was to highlight the need for a recognized reference standard to compare performance analyses across EMS. Methods This prospective observational study included all emergency calls received in Geneva’s dispatch centre between January 1st, 2016 and June 30th, 2019. Emergency medical dispatchers (EMD) assigned a level of risk to patients at the time of the initial call. Only the highest level of risk led to the dispatch of an EP. The severity of the patient’s condition observed in the field was measured using the National Advisory Committee for Aeronautics (NACA) scale. Two reference standards were proposed by dichotomizing the NACA scale. The first compared NACA≥4 with other conditions and the second compared NACA≥5 with other conditions. The level of risk identified during the initial call was then compared to the dichotomized NACA scales. Results 97′861 assessments were included. Overall prevalence of sending an EP as first line was 13.11, 95% CI [12.90–13.32], and second line was 2.94, 95% CI [2.84–3.05]. Including NACA≥4, prevalence was 21.41, 95% CI [21.15–21.67], sensitivity was 36.2, 95% CI [35.5–36.9] and specificity 93.2 95% CI [93–93.4]. The Area Under the Receiver-Operating Characteristics curve (AUROC) of 0.7507, 95% CI [0.74734–0.75397] was acceptable. Looking NACA≥5, prevalence was 3.09, 95% CI [2.98–3.20], sensitivity was 64.4, 95% CI [62.7–66.1] and specificity 88.5, 95% CI [88.3–88.7]. We found an excellent AUROC of 0.8229, 95% CI [0.81623–0.82950]. Conclusion The assessment by Geneva’s EMD has good specificity but low sensitivity for sending EPs. The dichotomy between immediate life-threatening and other emergencies could be a valid reference standard for future studies to measure the EP’s dispatching performance. Supplementary Information The online version contains supplementary material available at 10.1186/s13049-021-00844-y.
Collapse
Affiliation(s)
- Victor Nathan Chappuis
- Division of Emergency Medicine, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, CH 1211, Geneva, Switzerland
| | - Hélène Deham
- Division of Emergency Medicine, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, CH 1211, Geneva, Switzerland
| | - Philippe Cottet
- Division of Emergency Medicine, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, CH 1211, Geneva, Switzerland
| | - Birgit Andrea Gartner
- Division of Emergency Medicine, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, CH 1211, Geneva, Switzerland
| | - François Pierre Sarasin
- Division of Emergency Medicine, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, CH 1211, Geneva, Switzerland
| | - Marc Niquille
- Division of Emergency Medicine, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, CH 1211, Geneva, Switzerland
| | - Laurent Suppan
- Division of Emergency Medicine, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, CH 1211, Geneva, Switzerland
| | - Robert Larribau
- Division of Emergency Medicine, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, CH 1211, Geneva, Switzerland. .,Division of Emergency Medicine, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospital, Chemin du Petit-Bel-Air 2, CH 1226, Geneva, Thônex, Switzerland.
| |
Collapse
|
29
|
Rikken QGH, Mikdad S, Mota MTC, De Leeuw MA, Schober P, Schwarte LA, Giannakopoulos GF. Operational experience of the Dutch helicopter emergency medical services (HEMS) during the initial phase of the COVID-19 pandemic: jeopardy on the prehospital care system? Eur J Trauma Emerg Surg 2021; 47:703-711. [PMID: 33438040 PMCID: PMC7802610 DOI: 10.1007/s00068-020-01569-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 12/02/2020] [Indexed: 11/08/2022]
Abstract
Purpose The SARS-CoV-2 virus has disrupted global and local medical supply chains. To combat the spread of the virus and prevent an uncontrolled outbreak with limited resources, national lockdown protocols have taken effect in the Netherlands since March 13th, 2020. The aim of this study was to describe the incidence, type and characteristics of HEMS and HEMS-ambulance ‘Lifeliner 1’ dispatches during the initial phase of the COVID-19 pandemic compared to the same period one year prior. Methods A retrospective review of all HEMS and HEMS-ambulance ‘Lifeliner 1’ dispatches was performed from the start of Dutch nationwide lockdown orders from March 13th until May 13th, 2020 and the corresponding period one year prior. Dispatch-, operational-, patient-, injury-, and on-site treatment characteristics were extracted for analysis. In addition, the rate of COVID-19 positively tested HEMS personnel and the time physicians were unable to take call was described. Results During the initial phase of the COVID-19 pandemic, the HEMS and HEMS-ambulance was requested in 528 cases. One year prior, a total of 620 requests were received. The HEMS (helicopter and ambulance) was cancelled after deployment in 56.4% of the COVID-19 cohort and 50.7% of the historical cohort (P = 0.05). Incident location type did not differ between the two cohorts, specifically, there was no significant difference in the number of injuries that occurred at home in pandemic versus non-pandemic circumstances. Besides a decrease in the number of falls, the distribution of mechanisms of injury remained similar during the COVID-19 study period. There was no difference in self-inflicted injuries observed. Prehospital interventions remained similar during the COVID-19 pandemic compared to one year prior. Specifically, prehospital intubation did not differ between the two cohorts. The rate of COVID-19 positively tested HEMS personnel was 23.1%. Physicians who tested positive were unable to take call for a mean of 25 days (range 8–53). Conclusion A decrease in the number of deployments and increase in the number of cancelled missions was observed during the COVID-19 study period. No major differences in operational- and injury characteristics were found for HEMS and HEMS-ambulance dispatches between the initial phase of the COVID-19 pandemic in the Netherlands and the same period one year prior. These findings highlight the importance of continued operability of the HEMS, even during pandemic circumstances. Level of evidence III, retrospective comparative study.
Collapse
Affiliation(s)
- Quinten G H Rikken
- Trauma Center, Department of Surgery, Location AMC and Location VUmc, Amsterdam University Medical Centres, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Sarah Mikdad
- Trauma Center, Department of Surgery, Location AMC and Location VUmc, Amsterdam University Medical Centres, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Mathijs T Carvalho Mota
- Trauma Center, Department of Surgery, Location AMC and Location VUmc, Amsterdam University Medical Centres, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Marcel A De Leeuw
- Department of Anesthesiology, Location AMC and Location VUmc, Amsterdam University Medical Centres, Amsterdam, Netherlands
| | - Patrick Schober
- Trauma Center, Department of Surgery, Location AMC and Location VUmc, Amsterdam University Medical Centres, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.,Department of Anesthesiology, Location AMC and Location VUmc, Amsterdam University Medical Centres, Amsterdam, Netherlands
| | - Lothar A Schwarte
- Trauma Center, Department of Surgery, Location AMC and Location VUmc, Amsterdam University Medical Centres, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.,Department of Anesthesiology, Location AMC and Location VUmc, Amsterdam University Medical Centres, Amsterdam, Netherlands
| | - Georgios F Giannakopoulos
- Trauma Center, Department of Surgery, Location AMC and Location VUmc, Amsterdam University Medical Centres, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| |
Collapse
|
30
|
Hauch H, El Mohaui N, Wolff JEA, Vaillant V, Brill S, Schneck E, Ströter N, Sibelius U, Kriwy P, Berthold D. Out-of-Hospital Emergencies in Children Under Palliative Home Care. Front Pediatr 2021; 9:734181. [PMID: 35004533 PMCID: PMC8727697 DOI: 10.3389/fped.2021.734181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 11/30/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction: Specialized palliative home care (SPHC) enables children and adolescents with life-limiting illnesses and complex needs to receive care at home. In addition to controlling symptoms and stabilizing the psychosocial situation, crisis anticipation is a component of SPHC. Since the establishment of the reporting SPHC team, parents have called for additional help from emergency medical services (EMS) in emergency situations with unexpected frequency. Children with life limiting diseases could undergo invasive procedures and unhelpful treatments with uncertain consequences. The questions arose as to which factors led to the involvement of the EMS in a palliative situation, what therapy was performed and what outcome could be reached. Methods: Records of the pediatric SPHC patients and EMS call-outs in these children of the reporting SPHC-team in the central region of Hesse, Germany (population: 1.1 million) were retrospectively analyzed from 01.11.2014 to 01.05.2021. The causes of the call-outs, the existence of an emergency agreement, the National Advisory Committee for Aeronautics (NACA) score, EMS therapy and outcome were examined. Patient data included age, palliative-justifying diagnosis, duration and intensity of care, place of death and median overall survival (MOS) and palliative SHPC treatment. Results: In total, 172 patients were analyzed during the study period. There were 27 EMS calls for a total of 20 patients/families (= EMS group). Palliative illness or a complication was the most frequent cause of call-outs. The patients in the EMS group were significantly less likely to have a DNR order, required more home visits and telephone calls and were under SPHC care for longer. There was a significantly higher proportion of crisis interventions at home visits. The children in the EMS group died less often from the underlying disease. Of the remaining 152 patients (= non-EMS group), a significantly higher proportion had a European home country. Conclusions: Despite the introduction of the SPHC, parents still call the EMS. Good cooperation and joint training should be sought to prepare all those involved for future call-outs.
Collapse
Affiliation(s)
- Holger Hauch
- Palliative Care Team for Children, University Children's Hospital Giessen, Giessen, Germany
| | - Naual El Mohaui
- Palliative Care Team for Children, University Children's Hospital Giessen, Giessen, Germany
| | | | - Vera Vaillant
- Palliative Care Team for Children, University Children's Hospital Giessen, Giessen, Germany
| | - Sabine Brill
- Palliative Care Team for Children, University Children's Hospital Giessen, Giessen, Germany
| | - Emmanuel Schneck
- Anesthesiology and Intensive Medicine, University Hospital Giessen, Giessen, Germany
| | - Natascha Ströter
- Pediatric Oncology, University Children's Hospital Giessen, Giessen, Germany
| | - Ulf Sibelius
- Palliative Care Team for Adults, University Hospital Giessen, Giessen, Germany
| | - Peter Kriwy
- Institute of Sociology, Chemnitz University of Technology, Chemnitz, Germany
| | - Daniel Berthold
- Palliative Care Team for Adults, University Hospital Giessen, Giessen, Germany
| |
Collapse
|
31
|
Schemke S, Schwalbe H, Grunewald L, Maurer H. [Emergency medicine in the German Maritime Search and Rescue Service-Evaluation of medical emergencies in the North Sea and Baltic Sea over 2 years]. Anaesthesist 2020; 70:280-290. [PMID: 33231714 PMCID: PMC8026439 DOI: 10.1007/s00101-020-00885-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 09/11/2020] [Accepted: 09/23/2020] [Indexed: 11/25/2022]
Abstract
Hintergrund Die logistischen Besonderheiten eines maritimen Notfallortes und die häufig zusätzlich drohende akzidentelle Hypothermie machen die Versorgung medizinischer Notfälle auf dem Meer besonders anspruchsvoll. In dieser Arbeit sollen die Charakteristika notfallmedizinischer Einsätze der Deutschen Gesellschaft zur Rettung Schiffbrüchiger (DGzRS) als Hauptträgerin der nichthelikopterbasierten medizinischen Seenotrettung auf den Meeren vor der deutschen Küste beschrieben werden. Material und Methoden Es erfolgte eine retrospektive Analyse aller Einsätze der DGzRS der Jahre 2017 und 2018. Die Einsatzdaten und –zeiten sowie die Erkrankungsschwere der Patienten (graduiert mittels NACA-Score) wurden ausgewertet und exemplarisch mit denen eines NEF der Hansestadt Lübeck verglichen. Ergebnisse Bei insgesamt 182 medizinischen Einsätzen wurden 224 Patienten behandelt. Die Einsatzeinheiten der DGzRS benötigten im Mittel 30 ± 21 min bis zur Ankunft und 43 ± 30 min für Rettung, Behandlung und Transport. Bei 63 Einsätzen wurden die Patienten durch einen Notarzt betreut, der bei 44 Einsätzen durch die Landrettung herangeführt wurde. Durch die Wartezeit auf bordfremdes Personal wurde bei 26 Einsätzen die Abfahrt um im Mittel 18 ± 7 min verzögert. Die durchschnittliche Erkrankungsschwere in der Seenotrettung war signifikant höher als im Lübecker Notarztdienst; es gab vergleichbar häufig Reanimationen und Todesfälle. Schlussfolgerung Trotz der hohen Krankheitsschwere medizinischer Notfälle auf den Meeren vor Deutschlands Küste treffen Notärzte dort häufig mit erheblicher Verzögerung ein. Es gibt den dringenden Bedarf effektiverer Unterstützung der DGzRS durch für den maritimen Einsatz ausgebildetes ärztliches Personal.
Collapse
Affiliation(s)
- S Schemke
- Universität zu Lübeck, Klinik für Anästhesiologie, Lübeck, Deutschland.
- Deutsche Gesellschaft zur Rettung Schiffbrüchiger (DGzRS), Bremen, Deutschland.
- Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Klinik für Anästhesiologie und Intensivmedizin, Ratzeburger Allee 160, 23562, Lübeck, Deutschland.
| | - H Schwalbe
- Deutsche Gesellschaft zur Rettung Schiffbrüchiger (DGzRS), Bremen, Deutschland
| | - L Grunewald
- Universität zu Lübeck, Klinik für Anästhesiologie, Lübeck, Deutschland
| | - H Maurer
- Universität zu Lübeck, Klinik für Anästhesiologie, Lübeck, Deutschland
- Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Klinik für Anästhesiologie und Intensivmedizin, Ratzeburger Allee 160, 23562, Lübeck, Deutschland
| |
Collapse
|
32
|
Larribau R, Chappuis VN, Cottet P, Regard S, Deham H, Guiche F, Sarasin FP, Niquille M. Symptom-Based Dispatching in an Emergency Medical Communication Centre: Sensitivity, Specificity, and the Area under the ROC Curve. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17218254. [PMID: 33182228 PMCID: PMC7664854 DOI: 10.3390/ijerph17218254] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/01/2020] [Accepted: 11/06/2020] [Indexed: 06/11/2023]
Abstract
Measuring the performance of emergency medical dispatch tools used in paramedic-staffed emergency medical communication centres (EMCCs) is rarely performed. The objectives of our study were, therefore, to measure the performance and accuracy of Geneva's dispatch system based on symptom assessment, in particular, the performance of ambulance dispatching with lights and sirens (L&S) and to measure the effect of adding specific protocols for each symptom. Methods: We performed a prospective observational study including all emergency calls received at Geneva's EMCC (Switzerland) from 1 January 2014 to 1 July 2019. The risk levels selected during the emergency calls were compared to a reference standard, based on the National Advisory Committee for Aeronautics (NACA) scale, dichotomized to severe patient condition (NACA ≥ 4) or stable patient condition (NACA < 4) in the field. The symptom-based dispatch performance was assessed using a receiver operating characteristic (ROC) curve. Contingency tables and a Fagan nomogram were used to measure the performance of the dispatch with or without L&S. Measurements were carried out by symptom, and a group of symptoms with specific protocols was compared to a group without specific protocols. Results: We found an acceptable area under the ROC curve of 0.7474, 95%CI (0.7448-0.7503) for the 148,979 assessments included in the study. Where the severity prevalence was 21%, 95%CI (20.8-21.2). The sensitivity of the L&S dispatch was 87.5%, 95%CI (87.1-87.8); and the specificity was 47.3%, 95%CI (47.0-47.6). When symptom-specific assessment protocols were used, the accuracy of the assessments was slightly improved. Conclusions: Performance measurement of Geneva's symptom-based dispatch system using standard diagnostic test performance measurement tools was possible. The performance was found to be comparable to other emergency medical dispatch systems using the same reference standard. However, the implementation of specific assessment protocols for each symptom may improve the accuracy of symptom-based dispatch systems.
Collapse
|
33
|
Waje-Andreassen A, Østerås Ø, Brattebø G. A prospective observational study of why people are medically evacuated from offshore installations in the North Sea. BMJ Open 2020; 10:e037558. [PMID: 32641365 PMCID: PMC7342818 DOI: 10.1136/bmjopen-2020-037558] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 05/11/2020] [Accepted: 06/01/2020] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES Few studies have described evacuations due to medical emergencies from the offshore installations in the North Sea, though efficient medical service is essential for the industrial activities in this area. The major oil- and gas-producing companies' search and rescue (SAR) service is responsible for medical evacuations. Using a prospective approach, we describe the characteristics of patients evacuated by SAR. DESIGN AND SETTING A prospective observational study of the offshore primary care provided by SAR in the North Sea. METHODS Patients were identified by linking flight information from air transport services in 2015/2016 and the company's medical record system. Standardised forms filled out by SAR nurses during the evacuation were also analysed. In-hospital information was obtained retrospectively from Haukeland University Hospital's information system. RESULTS A total of 381 persons (88% men) were evacuated during the study period. Twenty-seven per cent of missions were due to chest pain and 18% due to trauma. The mean age was 46.0 years. Severity scores were higher for cases due to medical conditions compared with trauma, but the scores were relatively low compared with onshore emergency missions. The busiest months were May, July and December. Weekends were the busiest days. CONCLUSION Three times as many evacuations from offshore installations are performed due to acute illness than trauma, and cardiac problems are the most common. Although most patients are not severely physiologically deranged, the study documents a need for competent SAR services 24 hours a day year-round. Training and certification should be tailored for the SAR service, as the offshore health service structure and geography differs from the structure onshore.
Collapse
Affiliation(s)
- Anne Waje-Andreassen
- Department of Anaesthesia & Intensive Care, Haukeland University Hospital, Bergen, Norway
| | - Øyvind Østerås
- Department of Anaesthesia & Intensive Care, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, Haukeland University Hospital, Bergen, Norway
| | - Guttorm Brattebø
- Department of Anaesthesia & Intensive Care, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, Haukeland University Hospital, Bergen, Norway
- National Advisory Unit on Trauma, Oslo University Hospital, Oslo, Norway
- National Advisory Unit on Medical Emergency Communication, Haukeland University Hospital, Bergen, Norway
| |
Collapse
|
34
|
Zingg T, Piaget-Rossel R, Steppacher J, Carron PN, Dami F, Borens O, Albrecht R, Darioli V, Taffé P, Maudet L, Pasquier M. Prehospital use of pelvic circumferential compression devices in a physician-based emergency medical service: A 6-year retrospective cohort study. Sci Rep 2020; 10:5106. [PMID: 32198451 PMCID: PMC7083961 DOI: 10.1038/s41598-020-62027-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 03/06/2020] [Indexed: 11/20/2022] Open
Abstract
Fractures of the pelvic ring are a potential source of significant bleeding. Pelvic circumferential compression devices (PCCDs) can reduce and immobilize unstable fractures, but their hemostatic effect is unproven. Our aim was to assess the current practice of prehospital PCCD application and to identify factors available in the field predictive of significant pelvic ring injuries. All interventions (n = 13,435) in the Lausanne University Hospital Emergency Medical Service (EMS) were screened for PCCD placements from January 2008 to November 2014. Significant pelvic ring injuries (Tile types B or C) were considered as potentially benefitting from a PCCD. Data were extracted from the local prehospital registry. During the study period, 2366 trauma missions were performed. A PCCD was applied to 552/2366 (23%) patients. Significant pelvic ring injuries were present in 105/2366 (4.4%). Factors associated with the presence of significant pelvic ring injury were increased respiratory rate (OR 1.04), prolonged capillary refill time (OR 2.11), increased shock index (OR 3.91), pedestrians hit by a vehicle (OR 2.19), and presenting with falls from more than 2 m (OR 1.91). Among patients with a significant pelvic ring injury, a PCCD was placed in 79 (75%) and omitted in 26 (25%). One sixth of patients with a PCCD had a final diagnosis of significant pelvic ring injury. Further studies are needed to better understand which patient-, or accident-related factors are associated with prehospital PCCD omission among patients with significant pelvic ring injury.
Collapse
Affiliation(s)
- Tobias Zingg
- Department of Visceral Surgery, Lausanne University Hospital - CHUV, Lausanne, Switzerland.
| | - Romain Piaget-Rossel
- Center for Primary Care and Public Health, University of Lausanne, Lausanne, Switzerland
| | - Julie Steppacher
- School of Medicine and Biology, University of Lausanne, Lausanne, Switzerland
| | - Pierre-Nicolas Carron
- Department of Emergency Medicine, Lausanne University Hospital - CHUV, Lausanne, Switzerland
| | - Fabrice Dami
- Department of Emergency Medicine, Lausanne University Hospital - CHUV, Lausanne, Switzerland
| | - Olivier Borens
- Department of Orthopedics and Traumatology, Lausanne University Hospital - CHUV, Lausanne, Switzerland
| | | | - Vincent Darioli
- Department of Emergency Medicine, Lausanne University Hospital - CHUV, Lausanne, Switzerland
| | - Patrick Taffé
- Center for Primary Care and Public Health, University of Lausanne, Lausanne, Switzerland
| | - Ludovic Maudet
- Department of Emergency Medicine, Lausanne University Hospital - CHUV, Lausanne, Switzerland
| | - Mathieu Pasquier
- Department of Emergency Medicine, Lausanne University Hospital - CHUV, Lausanne, Switzerland
| |
Collapse
|
35
|
Strapatsas TG, Roderick J, Hammer J, Jeschke B. Auswirkungen von Sonderrechtsfahrten auf Fahrzeiten: Aktuelle Situation in einer städtischen Umgebung. Notf Rett Med 2020. [DOI: 10.1007/s10049-019-00663-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
36
|
Neonatal Transport in the Practice of the Crews of the Polish Medical Air Rescue: A Retrospective Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17030705. [PMID: 31978982 PMCID: PMC7037463 DOI: 10.3390/ijerph17030705] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 01/19/2020] [Accepted: 01/20/2020] [Indexed: 01/01/2023]
Abstract
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.
Collapse
|
37
|
Dami F, Darioli V, Pasquier M. Association between the NACA score and clinical outcomes. Am J Emerg Med 2020; 38:1692-1693. [PMID: 31954546 DOI: 10.1016/j.ajem.2020.01.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 01/10/2020] [Indexed: 11/29/2022] Open
Affiliation(s)
- Fabrice Dami
- Emergency Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Vincent Darioli
- Emergency Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Mathieu Pasquier
- Emergency Department, Lausanne University Hospital, Lausanne, Switzerland.
| |
Collapse
|
38
|
Alstrup K, Møller TP, Knudsen L, Hansen TM, Petersen JAK, Rognås L, Barfod C. Characteristics of patients treated by the Danish Helicopter Emergency Medical Service from 2014-2018: a nationwide population-based study. Scand J Trauma Resusc Emerg Med 2019; 27:102. [PMID: 31699120 PMCID: PMC6836366 DOI: 10.1186/s13049-019-0672-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 09/25/2019] [Indexed: 11/23/2022] Open
Abstract
Background A national Helicopter Emergency Medical Service (HEMS) was introduced in Denmark in 2014 to ensure the availability of physician-led critical care for all patients regardless of location. Appropriate dispatch of HEMS is known to be complex, and resource utilisation is a highly relevant topic. Population-based studies on patient characteristics are fundamental when evaluating and optimising a system. The aim of this study was to describe the patient population treated by the Danish HEMS in terms of demographics, pre-hospital diagnostics, severity of illness or injury, and the critical care interventions performed. Method The study is a retrospective nationwide population-based study based on data gathered from the Danish HEMS database. We included primary missions resulting in a patient encounter registered between October 1st 2014 and April 30th 2018. Results Of 13.391 dispatches registered in the study period we included 7133 (53%) primary missions with patient encounter: 4639 patients were air lifted to hospital, 174 patients were escorted to hospital by the HEMS physician in an ambulance, and in 2320 cases HEMS assisted the ground crew on scene but did not escort the patient to hospital. Patient age ranged from 0-99 years and 64% of the population were men. The median age was 60 years. The main diagnostic groups were cardio-vascular emergencies (41%), trauma (23%) and neurological emergencies (16%). In 61% of the cases, the patient was critically ill/injured corresponding to a NACA (National Advisory Committee for Aeronautics) score between 4 and 7 (both included). In more than one third of the missions a critical care intervention was performed. Ultrasound examination and endo-tracheal intubation were the critical care interventions most frequently performed (21% and 20%, respectively). Conclusion The national Danish HEMS primarily attends severely ill or injured patients and often perform critical care interventions. In addition, the Danish HEMS provides rapid transport to highly specialised treatment for patients in the more rural parts of the country. Patients with cardio-vascular emergencies, trauma and neurological emergencies are among those patient groups most commonly seen. We conclude that the overall dispatch profile appears appropriate but emphasise that continuous development and refinement is essential.
Collapse
Affiliation(s)
- Karen Alstrup
- Department of Research and Development, Pre-hospital Emergency Medical Services, Central Denmark Region, Olof Palmes Allé 34, 8200, Aarhus N, Denmark.
| | | | - Lars Knudsen
- Department of Anaesthesiology, Aarhus University Hospital, Aarhus, Denmark.,The Danish Air Ambulance, Aarhus, Denmark
| | | | - Jens Aage Kølsen Petersen
- Department of Anaesthesiology, Aarhus University Hospital, Aarhus, Denmark.,The Danish Air Ambulance, Aarhus, Denmark
| | - Leif Rognås
- Department of Research and Development, Pre-hospital Emergency Medical Services, Central Denmark Region, Olof Palmes Allé 34, 8200, Aarhus N, Denmark.,Department of Anaesthesiology, Aarhus University Hospital, Aarhus, Denmark.,The Danish Air Ambulance, Aarhus, Denmark
| | - Charlotte Barfod
- The Danish Air Ambulance, Aarhus, Denmark.,Copenhagen Emergency Medical Services, University of Copenhagen, Aarhus, Denmark
| |
Collapse
|
39
|
Lechleuthner A, Wesolowski M, Brandt S. Gestuftes Versorgungssystem im Kölner Rettungsdienst. Notf Rett Med 2019. [DOI: 10.1007/s10049-019-00644-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
40
|
Der Münchner NACA-Score für den Datensatz MIND3.1. Notf Rett Med 2019. [DOI: 10.1007/s10049-019-0623-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
41
|
Teuben M, Löhr N, Jensen KO, Brüesch M, Müller S, Pfeifer R, Mica L, Pape HC, Sprengel K. Improved pre-hospital care efficiency due to the implementation of pre-hospital trauma life support (PHTLS ®) algorithms. Eur J Trauma Emerg Surg 2019; 46:1321-1325. [PMID: 31079191 DOI: 10.1007/s00068-019-01141-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 04/17/2019] [Indexed: 11/24/2022]
Abstract
PURPOSE Pre-hospital trauma life support (PHTLS®) includes a standardized algorithm for pre-hospital care. Implementation of PHTLS® led to improved outcome in less developed medical trauma systems. We aimed to determine the impact of PHTLS® on quality of pre-hospital care in a European metropolitan area. We hypothesized that the introduction of PHTLS® was associated with improved efficiency of pre-hospital care for severely injured patients and less emergency physician deployment. METHODS We included adult polytrauma (ISS > 15) patients that were admitted to our level one trauma center during a 7-year time period. Patients were grouped based on the presence or absence of a PHTLS®-trained paramedic in the pre-hospital trauma team. Group I (no-PHTLS group) included all casualties treated by no-PHTLS®-trained personnel. Group II (PHTLS group) was composed of casualties managed by a PHTLS® qualified team. We compared outcome between groups. RESULTS During the study period, 187,839 rescue operations were executed and 280 patients were included. No differences were seen in patient characteristics, trauma severity or geographical distances between groups. Transfer times were significantly reduced in PHTLS® teams than non-qualified teams (9.3 vs. 10.5 min, P = 0.006). Furthermore, the in-field operation times were significantly reduced in PHTLS® qualified teams (36.2 vs. 42.6 min, P = 0.003). Emergency physician involvement did not differ between groups. CONCLUSION This is the first study to show that the implementation of PHTLS® algorithms in a European metropolitan area is associated with improved efficiency of pre-hospital care for the severely injured. We therefore recommend considering the introduction of PHTLS® in metropolitan areas in the first world.
Collapse
Affiliation(s)
- Michel Teuben
- Department of Traumatology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
| | - Nikolaus Löhr
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Kai Oliver Jensen
- Department of Traumatology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Martin Brüesch
- Institute of Anesthesiology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Stephan Müller
- City of Zurich, Schutz and Rettung, Neumuehlequai 40, 8021, Zurich, Switzerland
| | - Roman Pfeifer
- Department of Traumatology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Ladislav Mica
- Department of Traumatology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Hans-Christoph Pape
- Department of Traumatology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Kai Sprengel
- Department of Traumatology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| |
Collapse
|
42
|
Weinlich M, Martus P, Blau MB, Wyen H, Walcher F, Piatek S, Schüttrumpf JP. Competitive advantage gained from the use of helicopter emergency medical services (HEMS) for trauma patients: Evaluation of 1724 patients. Injury 2019; 50:1028-1035. [PMID: 30591228 DOI: 10.1016/j.injury.2018.12.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 12/14/2018] [Accepted: 12/15/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVES The aim of the study was to analyze helicopter emergency medical service (HEMS) in comparison to EMS, in respect to patient's mortality and morbidity. DESIGN From a cohort of traumatized patients (n = 1724) prospectively enrolled in the German trauma registry (DGU-R) at Frankfurt University Hospital from 2009 to 2013, 1646 could be analyzed for in-hospital mortality and short-term outcome (GOS) at discharge and compared between HEMS and EMS. MEASUREMENTS AND MAIN RESULTS 129 patients (7.8%) died in the hospital. Unadjusted mortality was significantly lower in the HEMS group compared to EMS (p = 0.001). In a multiple logistic regression analysis after adjustment of variables including reanimation and age as the strongest predictors, in-hospital mortality was significantly reduced in HEMS (p = 0.014, OR = 0.21). Further predictors in the multiple logistic regression analysis were GCS > = 8 (p = 0.001), RRsys (p < 0.001), ISS at Head/Neck > = 3 (p = 0.003), and total ISS > = 9 (p < 0.001). Total rescue time and on scene time were associated with mortality (p < 0.001) but not included in the multiple logistic regression model. Without adjustment, short-term outcome (GOS) was significantly improved (p = 0.014). In a linear model, after adjusting for multiple variables including age, ISS Head/Neck > = 3, ISS Extremities > = 3, GCS > = 8, and RRsys as the strongest predictors (p < 0.001), the association remained significant (p = 0.043). Further predictors in the multiple linear regression analysis were total ISS > = 9 (p = 0.002), ISS abdomen (p = 0.001), and ISS Chest (p = 0.011). CONCLUSIONS A significant improvement for in-hospital survival for HEMS could be demonstrated. Especially in Germany, with a high number of secondary call outs (about 44%) after EMS has already reached the traumatized patient, HEMS must be the first choice for severely injured trauma patients. Dispatch criteria for immediate alarm of HEMS are recommended under practical considerations.
Collapse
Affiliation(s)
- M Weinlich
- University of Magdeburg, Dept. of Trauma Surgery, Leipziger Str. 44, 39120, Magdeburg, Germany.
| | - P Martus
- University of Tübingen, Medical Center, Otfried-Müller Str. 10, 72076, Tübingen, Germany
| | - M B Blau
- University of Tübingen, Medical Center, Otfried-Müller Str. 10, 72076, Tübingen, Germany
| | - H Wyen
- University of Frankfurt, Dept. of Traumatology, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - F Walcher
- University of Magdeburg, Dept. of Trauma Surgery, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - S Piatek
- University of Magdeburg, Dept. of Trauma Surgery, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - J P Schüttrumpf
- University of Magdeburg, Dept. of Trauma Surgery, Leipziger Str. 44, 39120, Magdeburg, Germany
| |
Collapse
|
43
|
Helicopter Emergency Medical Service (HEMS) Response in Rural Areas in Poland: Retrospective Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16091532. [PMID: 31052200 PMCID: PMC6539897 DOI: 10.3390/ijerph16091532] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 04/25/2019] [Accepted: 04/30/2019] [Indexed: 01/07/2023]
Abstract
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.
Collapse
|
44
|
Alstrup K, Petersen JAK, Barfod C, Knudsen L, Rognås L, Møller TP. The Danish helicopter emergency medical service database: high quality data with great potential. Scand J Trauma Resusc Emerg Med 2019; 27:38. [PMID: 30953564 PMCID: PMC6451291 DOI: 10.1186/s13049-019-0615-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 03/12/2019] [Indexed: 11/24/2022] Open
Abstract
Background The Danish Helicopter Emergency Medical Service (HEMS) is part of the Danish pre-hospital response offering advanced patient care on scene and during rapid transport to definitive care. Monitoring HEMS performance and the quality of critical care has high national as well as international priority underlining the need for research in this field. The data quality of the Danish HEMS database is unknown. Furthermore, a set of quality indicators (QI) developed by an international collaboration group (EQUIPE) potentially for use in physician-staffed EMS, has recently been presented. The aim of the current study was to present the design and data quality of the Danish helicopter database, and to evaluate the coverage of available variables in the database according to the QIs proposed. Method The study included all helicopter dispatches between October 1st 2014 and April 30th 2018. The database layout and data entering procedure, as well as the key variables and data completeness were described. Furthermore, missing data and misclassifications were addressed. Lastly, the 26 QIs proposed by the EQUIPE-collaboration were evaluated for coverage in the HEMS database. Results A total of 13,392 missions were included in the study. The database includes a broad spectrum of mission- and patient-specific data related to the pre-hospital pathway of acutely ill or injured patients in a national coverage. Missing data for the majority of variables is less than 6.5%. The percentage of completed report forms has increased over time and reached 99.9% in 2018. Misclassification were observed for 294 patients in the study period corresponding to 3,7%. Less than half of the QIs proposed by the EQUIPE-collaboration group were directly available from the database. Conclusions Helicopter Emergency Medical Services in Denmark are a new and sparsely investigated health care provider. The database contains nearly all missions dispatched by the five regional Emergency Medical Dispatch Centres. Generally, the data quality is considered high with great potential for future research. Potential quality indicators as proposed by the EQUIPE-collaboration group could inspire the configuration and design of the next version of Hemsfile creating an even more solid basis for research and quality improvement. Electronic supplementary material The online version of this article (10.1186/s13049-019-0615-5) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Karen Alstrup
- Research and Development, Pre-hospital Emergency Medical Services, Central Denmark Region, Olof Palmes Allé 34, 8200, Aarhus N, Denmark.
| | - Jens Aage Kølsen Petersen
- Department of Anaesthesiology, Aarhus University Hospital, Aarhus, Denmark.,The Danish Air Ambulance, Aarhus, Denmark
| | - Charlotte Barfod
- The Danish Air Ambulance, Aarhus, Denmark.,Emergency Medical Services, Copenhagen, Denmark
| | - Lars Knudsen
- Department of Anaesthesiology, Aarhus University Hospital, Aarhus, Denmark.,The Danish Air Ambulance, Aarhus, Denmark
| | - Leif Rognås
- Research and Development, Pre-hospital Emergency Medical Services, Central Denmark Region, Olof Palmes Allé 34, 8200, Aarhus N, Denmark.,Department of Anaesthesiology, Aarhus University Hospital, Aarhus, Denmark.,The Danish Air Ambulance, Aarhus, Denmark
| | | |
Collapse
|
45
|
Pietsch U, Strapazzon G, Ambühl D, Lischke V, Rauch S, Knapp J. Challenges of helicopter mountain rescue missions by human external cargo: need for physicians onsite and comprehensive training. Scand J Trauma Resusc Emerg Med 2019; 27:17. [PMID: 30760298 PMCID: PMC6374883 DOI: 10.1186/s13049-019-0598-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 02/07/2019] [Indexed: 02/03/2023] Open
Abstract
Background Human external cargo (HEC) extrication during helicopter rescue missions is commonly used in mountain emergency medical services. Furthermore, longline or winch operations offer the opportunity to deliver professional medical care onsite. As the safety and quality of emergency medical care depends on training and experience, we aimed to investigate characteristics of mountain rescue missions with HEC. Methods We retrospectively reviewed all rescue missions conducted by Air Zermatt (a commercial rescue service in the high-alpine region of Switzerland) from January 2010 to September 2016. Results Out of 11,078 rescue missions 1137 (10%) required a HEC rescue. In 3% (n = 29) rapid sequence induction and endotracheal intubation, in 2% (n = 14) cardiopulmonary resuscitation, and in 0.4% (n = 3) a chest tube insertion had to be performed onsite prior to HEC extraction. The most common medical intervention onsite is analgesia or analgosedation, in 17% (n = 142) fentanyl or ketamine was used in doses of ≥ 0.2 mg or ≥ 50 mg, respectively. Conclusions As these interventions have to be performed in challenging terrain, with reduced personnel resources, and limited monitoring, our results point out the need for physicians onsite who are clinically experienced in these procedures and specially and intensively trained for the specific characteristics and challenges of HEC rescue missions.
Collapse
Affiliation(s)
- Urs Pietsch
- Department of Anaesthesiology and Intensive Care Medicine, Cantonal Hospital St. Gallen, Rorschacher Strasse 95, 9007, St. Gallen, Switzerland. .,Air Zermatt, Emergency Medical Service, 3920, Zermatt, Switzerland. .,Bergwacht Schwarzwald, Hessen, Bayern, Germany.
| | - Giacomo Strapazzon
- Institute of Mountain Emergency Medicine, Eurac Research, Bozen, Italy.,CNSAS Italian Mountain Rescue, Milan, Italy
| | - Dimitri Ambühl
- Medical School, University of Bern, Bern, Switzerland.,Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland
| | - Volker Lischke
- Air Zermatt, Emergency Medical Service, 3920, Zermatt, Switzerland.,Bergwacht Schwarzwald, Hessen, Bayern, Germany
| | - Simon Rauch
- Institute of Mountain Emergency Medicine, Eurac Research, Bozen, Italy.,Department of Anaesthesiology, University Hospital of Munich (LMU), Munich, Germany
| | - Jürgen Knapp
- Air Zermatt, Emergency Medical Service, 3920, Zermatt, Switzerland.,Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland
| |
Collapse
|
46
|
Pannatier M, Delhumeau C, Walder B. Comparison of two prehospital predictive models for mortality and impaired consciousness after severe traumatic brain injury. Acta Anaesthesiol Scand 2019; 63:74-85. [PMID: 30117150 DOI: 10.1111/aas.13229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 06/15/2018] [Accepted: 07/05/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND The primary aim was to investigate the performance of a National Advisory Committee for Aeronautics based predictive model (NACA-BM) for mortality at 14 days and a reference model using motor GCS (GCS-RM). The secondary aim was to compare the models for impaired consciousness of survivors at 14 days (IC-14; GCS ≤ 13). METHODS Patients ≥16 years having sustained TBI with an abbreviated injury scale score of head region (HAIS) of >3 were included. Multivariate logistic regression models were used to test models for death and IC-14. The discrimination was assessed using area under the receiver-operating curves (AUROCs); noninferiority margin was -5% between the AUROCs. Calibration was assessed using the Hosmer Lemeshow goodness-of-fit test. RESULTS Six hundred and seventy seven patients were included. The median age was 54 (IQR 32-71). The mortality rate was 31.6%; 99 of 438 surviving patients (22.6%) had an IC-14. Discrimination of mortality was 0.835 (95%CI 0.803-0.867) for the NACA-BM and 0.839 (0.807-0.872) for the GCS-RM; the difference of the discriminative ability was -0.4% (-2.3% to +1.7%). Calibration was appropriate for the NACA-BM (χ2 8.42; P = 0. 393) and for the GCS-RM (χ2 3.90; P = 0. 866). Discrimination of IC-14 was 0.757 (0.706-0.808) for the NACA-BM and 0.784 (0.734-0.835) for the GCS-RM; the difference of the discriminative ability was -2.5% (-7.8% to +2.6%). Calibration was appropriate for the NACA-BM (χ2 10.61; P = 0.225) and for the GCS-RM (χ2 6.26; P = 0.618). CONCLUSIONS Prehospital prediction of mortality after TBI was good with both models, and the NACA-BM was not inferior to the GCS-RM. Prediction of IC-14 was moderate in both models.
Collapse
Affiliation(s)
- Michel Pannatier
- Division of Anaesthesiology; University Hospitals of Geneva; Geneva Switzerland
| | - Cécile Delhumeau
- Division of Anaesthesiology; University Hospitals of Geneva; Geneva Switzerland
| | - Bernhard Walder
- Division of Anaesthesiology; University Hospitals of Geneva; Geneva Switzerland
| |
Collapse
|
47
|
The impact of the patient's initial NACA score on subjective and physiological indicators of workload during pre-hospital emergency care. PLoS One 2018; 13:e0202215. [PMID: 30092090 PMCID: PMC6084954 DOI: 10.1371/journal.pone.0202215] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Accepted: 07/29/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Excessive workload may impair patient safety. However, little is known about emergency care providers' workload during the treatment of life-threatening cases including cardiopulmonary resuscitation (CPR). Therefore, we tested the hypothesis that subjective and physiological indicators of workload are associated with the patient's initial NACA score and that workload is particularly high during CPR. METHODS NASA task load index (NASA-tlx) and alarm codes were obtained for 216 sorties of pre-hospital emergency medical care. Furthermore, initial NACA scores of 140 patients were extracted from the physicians' protocols. The physiological workload indicators mean heart rate (HR) and permutation entropy (PeEn) were calculated for 51 sorties of primary care. General linear mixed models were used to analyze the association of NACA scores with subjective (NASA-tlx) and physiological (mean HR, PeEn) measures of workload. RESULTS In contrast to the physiological variables PeEn (p = 0.10) and HR (p = 0.19), the mental (p<0.001) and temporal demands (p<0.001) as well as the effort (p<0.001) and frustration (p = 0.04) subscale of the NASA-tlx were significantly associated with initial NACA scores. Compared to NACA = I, an initial NACA score of VI (representing CPR) increased workload by a mean of 389.5% (p = 0.001) in the mental and 345.9% (p<0.001) in the temporal demands, effort by a mean of 446,8% (p = 0.002) and frustration by 190.0% (p = 0.03). In line with the increase in NASA-tlx, PeEn increased by 20.6% (p = 0.01) and HR by 6.4% (p = 0.57). CONCLUSIONS Patients' initial NACA scores are associated with subjective workload. Workload was highest during CPR.
Collapse
|
48
|
Kottmann A, Carron PN, Theiler L, Albrecht R, Tissi M, Pasquier M. Identification of the technical and medical requirements for HEMS avalanche rescue missions through a 15-year retrospective analysis in a HEMS in Switzerland: a necessary step for quality improvement. Scand J Trauma Resusc Emerg Med 2018; 26:54. [PMID: 29973290 PMCID: PMC6033290 DOI: 10.1186/s13049-018-0520-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 06/11/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Avalanche rescues mostly rely on helicopter emergency medical services (HEMS) and include technical rescue and complex medical situations under difficult conditions. The adequacy of avalanche victim management has been shown to be unexpectedly low, suggesting the need for quality improvement. We analyse the technical rescue and medical competency requirements of HEMS crewmembers for avalanche rescue missions, as well as their clinical exposure. The study aims to identify areas that should be the focus of future quality improvement efforts. METHODS This 15-year retrospective study of avalanche rescue by the Swiss HEMS Rega includes all missions where at least one patient had been caught by an avalanche, found within 24 h of the alarm being raised, and transported. RESULTS Our analyses included 422 missions (596 patients). Crews were frequently confronted with technical rescue aspects, including winching (29%) and patient location and extrication (48%), as well as multiple casualty accidents (32%). Forty-seven percent of the patients suffered potential or overt vital threat; 29% were in cardiac arrest. The on-site medical management of the victims required a large array of basic and advanced medical skills. Clinical exposure was low, as 56% of the physicians were involved in only one avalanche rescue mission over the study period. CONCLUSIONS Our data provide a solid baseline measure and valuable starting point for improving our understanding of the challenges encountered during avalanche rescue missions. We further suggest QI interventions, that might be immediately useful for HEMS operating under similar settings. A coordinated approach using a consensus process to determine quality indicators and a minimal dataset for the specific setting of avalanche rescue would be the logical next step.
Collapse
Affiliation(s)
- Alexandre Kottmann
- Emergency Department, Lausanne University Hospital, Lausanne, Switzerland
- Swiss Air Ambulance, Rega, Zürich, Switzerland
| | | | - Lorenz Theiler
- Swiss Air Ambulance, Rega, Zürich, Switzerland
- Department of Anesthesiology and Pain Medicine, Inselspital, Bern University Hospital, Bern, Switzerland
| | | | - Mario Tissi
- Swiss Air Ambulance, Rega, Zürich, Switzerland
| | - Mathieu Pasquier
- Emergency Department, Lausanne University Hospital, Lausanne, Switzerland
| |
Collapse
|
49
|
Samdal M, Haugland HH, Fjeldet C, Rehn M, Sandberg M. Static Rope Evacuation by Helicopter Emergency Medical Services in Rescue Operations in Southeast Norway. Wilderness Environ Med 2018; 29:315-324. [PMID: 29908723 DOI: 10.1016/j.wem.2018.03.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Revised: 03/08/2018] [Accepted: 03/26/2018] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Physician-staffed helicopter emergency medical services (HEMS) in Norway are an adjunct to existing search and rescue services. Our aims were to study the epidemiological, operational, and medical aspects of HEMS daylight static rope operations performed in the southeastern part of the country and to examine several quality dimensions that are characteristic of this service. METHODS We reviewed the static rope operations performed at 3 HEMS bases during a 3-y period and applied a set of quality indicators designed for physician-staffed emergency medical services to evaluate the quality of care. Data are presented as medians with quartiles, except National Advisory Committee for Aeronautics (NACA) scores, which are presented as mean (SD). RESULTS Fifty-nine static rope operations were identified, involving 60 patients. Median (quartiles) age was 43 (27-55) y. Median (quartiles) take-off time was 9 (5-13) min. Trauma-related injuries were found in 48 patients. The main conditions were lower limb injuries, found in 32 patients. Ten patients experienced medical conditions. Mean (SD) NACA score was 3.3 (1.3). A potential or actual life-threatening diagnosis (NACA score: 4-6) was reported among 15 patients. The main interventions were intravenous lines (19 patients), analgesics (17), and oxygen treatment (14). Four patients were intubated, and 1 thoracostomy was performed. CONCLUSIONS Static rope operations are rarely performed. The quality indicators suggest that the service is safe, available, and equitable. Its main benefit seems to be evacuation and the maintenance of readiness before rapid transport of the physician to the scene or the patient to the hospital.
Collapse
Affiliation(s)
- Martin Samdal
- Department of Research, Norwegian Air Ambulance Foundation, Drøbak (Drs Samdal, Haugland, and Rehn); Division of Emergencies and Critical Care, Department of Anesthesiology (Drs Samdal and Rehn).
| | - Helge H Haugland
- Department of Research, Norwegian Air Ambulance Foundation, Drøbak (Drs Samdal, Haugland, and Rehn); Department of Anesthesiology and Intensive Care, St. Olav's University Hospital, Trondheim, Norway (Dr Haugland)
| | - Cato Fjeldet
- Norwegian Air Ambulance, Evenes, Norway (Mr Fjeldet)
| | - Marius Rehn
- Department of Research, Norwegian Air Ambulance Foundation, Drøbak (Drs Samdal, Haugland, and Rehn); Division of Emergencies and Critical Care, Department of Anesthesiology (Drs Samdal and Rehn); Department of Health Studies, University of Stavanger, Stavanger, Norway (Dr Rehn)
| | - Mårten Sandberg
- Air Ambulance Department, Prehospital Clinic (Dr Sandberg), Oslo University Hospital, Oslo, Norway; Faculty of Medicine, University of Oslo, Oslo, Norway (Dr Sandberg)
| |
Collapse
|
50
|
Gałązkowski R, Farkowski MM, Rabczenko D, Marciniak-Emmons M, Darocha T, Timler D, Sterliński M. Additional data from clinical examination on site significantly but marginally improve predictive accuracy of the Revised Trauma Score for major complications during Helicopter Emergency Medical Service missions. Arch Med Sci 2018; 14:865-870. [PMID: 30002706 PMCID: PMC6040125 DOI: 10.5114/aoms.2016.61884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 05/18/2016] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION The Revised Trauma Score (RTS) accurately identifies trauma patients at high risk of adverse events or death. Less is known about its usefulness in the general population and non-trauma recipients of Helicopter Emergency Medical Service (HEMS). The RTS is a simple tool and omits a lot of other data obtained during clinical evaluation. The aim was to assess the role of the RTS to identify patients at risk of major complications (death, cardiopulmonary resuscitation, defibrillation, intubation) in the general population of HEMS patients. Clinical factors beyond the RTS were analyzed to identify additional prognostic factors for predicting major complications. MATERIAL AND METHODS A retrospective analysis of medical records of adult patients routinely collected during HEMS missions in the years 2011-2014 was performed. RESULTS The analysis included 19 554 HEMS missions. Patients were 55 ±20 years old and 68% were male. The most common indication for HEMS was diseases of the circulatory system - 41%. Major complications occurred in 2072 (10.6%) cases. In the general population of HEMS patients, the RTS accurately identified individuals at risk of major complications at a cut-off value of 10.5 and area under the curve (AUC) of 93.5%. In multivariate analysis, additional clinical data derived from clinical examination (ECG; skin, pupil and breathing examination) significantly but marginally improved the accuracy of RTS assessment: AUC 95.6% (p < 0.001 for the difference). CONCLUSIONS The Revised Trauma Score accurately identifies individuals at risk of major complications during HEMS missions regardless of the indication. Additional clinical data significantly but marginally improved the accuracy of RTS in the general population of HEMS patients.
Collapse
Affiliation(s)
- Robert Gałązkowski
- Department of Emergency Medical Services, Medical University of Warsaw, Warsaw, Poland
| | - Michał M. Farkowski
- Second Department of Coronary Artery Disease, Institute of Cardiology, Warsaw, Poland
| | - Daniel Rabczenko
- Department for Monitoring and Analysis of Population Health Status, National Institute of Public Health – National Institute of Hygiene, Warsaw, Poland
| | | | - Tomasz Darocha
- Department of Anesthesiology and Intensive Care, John Paul II Hospital, Medical College Jagiellonian University, Krakow, Poland
- Polish Medical Air Rescue, Krakow, Poland
| | - Dariusz Timler
- Department of Emergency Medicine and Disaster Medicine, Medical University of Lodz, Lodz, Poland
| | - Maciej Sterliński
- Second Department of Coronary Artery Disease, Institute of Cardiology, Warsaw, Poland
| |
Collapse
|