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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.
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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
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First Successful Rescue of a Lost Person Using the Human Detection System: A Case Study from Beskid Niski (SE Poland). REMOTE SENSING 2021. [DOI: 10.3390/rs13234903] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Recent advances in search and rescue methods include the use of unmanned aerial vehicles (UAVs), to carry out aerial monitoring of terrains to spot lost individuals. To date, such searches have been conducted by human observers who view UAV-acquired videos or images. Alternatively, lost persons may be detected by automated algorithms. Although some algorithms are implemented in software to support search and rescue activities, no successful rescue case using automated human detectors has been reported on thus far in the scientific literature. This paper presents a report from a search and rescue mission carried out by Bieszczady Mountain Rescue Service near the village of Cergowa in SE Poland, where a 65-year-old man was rescued after being detected via use of SARUAV software. This software uses convolutional neural networks to automatically locate people in close-range nadir aerial images. The missing man, who suffered from Alzheimer’s disease (as well as a stroke the previous day) spent more than 24 h in open terrain. SARUAV software was allocated to support the search, and its task was to process 782 nadir and near-nadir JPG images collected during four photogrammetric flights. After 4 h 31 min of the analysis, the system successfully detected the missing person and provided his coordinates (uploading 121 photos from a flight over a lost person; image processing and verification of hits lasted 5 min 48 s). The presented case study proves that the use of an UAV assisted by SARUAV software may quicken the search mission.
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3
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Mulvey JM, Shaw BH, Betzner M, Chang E, Wardle M, Lobay K, Bezanson J. Columbia Icefield Bus Rollover: A Case Study of Wilderness Mass Casualty Triage, Treatment, and Transport. PREHOSP EMERG CARE 2021; 26:608-616. [PMID: 34060980 DOI: 10.1080/10903127.2021.1937412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Mass casualty incidents (MCIs) are rare in wilderness and mountain settings. Few case studies have reported the response of such events within jurisdictions with well-developed trauma and emergency medical services systems (EMS). Here we explore a MCI in a wilderness setting on the Columbia Icefield inside the Jasper National Park within the Canadian Rocky Mountains. An all-terrain bus was involved that had rolled over while transporting tourists to explore the glacier. The bus rolled multiple times down the slope adjacent to the road, leading to 3 deceased and 21 patients requiring transport. A massive pre-hospital response ensued.Due to the location, extreme environment, and unusual complexities, the response involved significant use of aeromedical resources, physician field deployment, and centralized coordination centers. Readers are reminded of the importance of aeromedical surge capacity in allowing for effective distribution of patients to multiple receiving facilities. Our experience aligns with and reinforces many of the recommendations for wilderness MCI management; however, future research should focus on determining optimal triage strategies for mountain MCIs. Furthermore, future research should explore optimal strategies for developing a rescue chain given the availability of mixed transport resources, as well as the role of physicians in MCI response and where they are best placed in the incident command system.
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Affiliation(s)
- Jamin M Mulvey
- Shock Trauma Air Rescue Service, (STARS), Alberta, Canada.,Department of Anesthesia, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Brett H Shaw
- Shock Trauma Air Rescue Service, (STARS), Alberta, Canada.,Department of Emergency Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Michael Betzner
- Shock Trauma Air Rescue Service, (STARS), Alberta, Canada.,Department of Emergency Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Eddie Chang
- Shock Trauma Air Rescue Service, (STARS), Alberta, Canada.,Department of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Mackenzie Wardle
- Shock Trauma Air Rescue Service, (STARS), Alberta, Canada.,EMS, Banff, Alberta, Canada
| | - Kevin Lobay
- Shock Trauma Air Rescue Service, (STARS), Alberta, Canada.,Department of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Joshua Bezanson
- Shock Trauma Air Rescue Service, (STARS), Alberta, Canada.,Department of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada
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4
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McRae JN, Nielsen BM, Gay CJ, Hunt AP, Nigh AD. Utilizing Drones to Restore and Maintain Radio Communication During Search and Rescue Operations. Wilderness Environ Med 2021; 32:41-46. [PMID: 33518495 DOI: 10.1016/j.wem.2020.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 11/09/2020] [Accepted: 11/10/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The ability of rescuers to maintain contact with incident command (IC) and each other is a critical component of search and rescue (SAR) operations. When rescuers lose radio communication with operation leaders, the effectiveness of operations may be substantially affected. This often occurs owing to the limitations of standard communications equipment in difficult terrain or when victims are beyond line-of-sight. This study investigates the viability of using an aerial drone-repeater system configuration to restore and maintain radio communications between IC and deployed rescuers. METHODS SAR operators in Southern Utah identified 10 areas where radio communication is compromised during live rescue operations. Trained SAR personnel were deployed to these areas in a mock exercise. After confirmed loss of communication, a repeater-equipped aerial drone was piloted 122 m above IC to restore communication. Once restored, communication was assessed at regular intervals for the duration of the mock deployment. RESULTS In all 10 areas tested, communication was successfully restored. In all cases, once communication was restored, no additional loss of radio contact occurred. The time between communication loss and restoration across the 10 scenarios was 6.5±1.1 (4.4-9.3) min (mean±SD with range). CONCLUSIONS This method of restoring radio communication among SAR personnel could drastically improve the ability to assist victims and help mitigate the risks faced by rescuers. SAR leaders should be made aware of the useful applications of drones during SAR operations, especially in instances where communication is compromised.
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Affiliation(s)
- Jake N McRae
- Rocky Vista University College of Osteopathic Medicine, Ivins, UT.
| | | | | | - Andrew P Hunt
- Rocky Vista University College of Osteopathic Medicine, Ivins, UT
| | - Andrew D Nigh
- Rocky Vista University College of Osteopathic Medicine, Ivins, UT
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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.
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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
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6
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Pietsch U, Knapp J, Kreuzer O, Ney L, Strapazzon G, Lischke V, Albrecht R, Phillips P, Rauch S. Advanced airway management in hoist and longline operations in mountain HEMS - considerations in austere environments: a narrative review This review is endorsed by the International Commission for Mountain Emergency Medicine (ICAR MEDCOM). Scand J Trauma Resusc Emerg Med 2018; 26:23. [PMID: 29615073 PMCID: PMC5883516 DOI: 10.1186/s13049-018-0490-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 03/19/2018] [Indexed: 12/19/2022] Open
Abstract
Background Providing sufficient oxygenation and ventilation is of paramount importance for the survival of emergency patients. Therefore, advanced airway management is one of the core tasks for every rescue team. Endotracheal intubation is the gold standard to secure the airway in the prehospital setting. This review aims to highlight special considerations for advanced airway management preceding human external cargo (HEC) evacuations. Methods We systematically searched MEDLINE, EMBASE, and PubMed in August 2017 for articles on airway management and ventilation in patients before hoist or longline operation in HEMS. Relevant reference lists were hand-searched. Results Three articles with regard to advanced airway management and five articles concerning the epidemiology of advanced airway management in hoist or longline rescue missions were included. We found one case report regarding ventilation during hoist operations. The exact incidence of advanced airway management before evacuation of a patient by HEC is unknown but seems to be very low (< 5%). There are several hazards which can impede mechanical ventilation of patients during HEC extractions: loss of equipment, hyperventilation, inability to ventilate and consequent hypoxia, as well as inadequacy of monitoring. Conclusions Advanced airway management prior to HEC operation is rarely performed. If intubation before helicopter hoist operations (HHO) and human cargo sling (HCS) extraction is considered by the rescue team, a risk/benefit analysis should be performed and a clear standard operating procedure (SOP) should be defined. Continuous and rigorous training including the whole crew is required. An international registry on airway management during HEC extraction would be desirable.
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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, Heliport Zermatt, 3920, Zermatt, Switzerland. .,Bergwacht (German Mountain Rescue Service), Carstennstrasse 58, 12205, Berlin, Germany.
| | - Jürgen Knapp
- Air Zermatt, Emergency Medical Service, Heliport Zermatt, 3920, Zermatt, Switzerland.,Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010, Bern, Switzerland
| | - Oliver Kreuzer
- Air Zermatt, Emergency Medical Service, Heliport Zermatt, 3920, Zermatt, Switzerland
| | - Ludwig Ney
- Air Zermatt, Emergency Medical Service, Heliport Zermatt, 3920, Zermatt, Switzerland.,Bergwacht (German Mountain Rescue Service), Carstennstrasse 58, 12205, Berlin, Germany.,Department of Anaesthesiology, University Hospital of Munich (LMU), 80336, Munich, Germany
| | - Giacomo Strapazzon
- Institute of Mountain Emergency Medicine, EURAC Research, Viale Druso 1, 39100, Bozen, Italy
| | - Volker Lischke
- Air Zermatt, Emergency Medical Service, Heliport Zermatt, 3920, Zermatt, Switzerland.,Bergwacht (German Mountain Rescue Service), Carstennstrasse 58, 12205, Berlin, Germany
| | - Roland Albrecht
- Department of Anaesthesiology and Intensive Care Medicine, Cantonal Hospital St. Gallen, Rorschacher Strasse 95, 9007, St. Gallen, Switzerland.,Swiss Air-Ambulance (REGA), P.O. Box 1414, 8058, Zurich, Switzerland
| | - Patrick Phillips
- Travis County STAR Flight, 7800 Old Manor Rd, Austin, TX, 78724, USA
| | - Simon Rauch
- Institute of Mountain Emergency Medicine, EURAC Research, Viale Druso 1, 39100, Bozen, Italy
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7
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Stanton NA, Roberts AP, Plant KL, Allison CK, Harvey C. Head-up displays assist helicopter pilots landing in degraded visual environments. THEORETICAL ISSUES IN ERGONOMICS SCIENCE 2017. [DOI: 10.1080/1463922x.2017.1394506] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Neville A. Stanton
- Transportation Research Group, Boldrewood Innovation Campus, University of Southampton, Southampton, United Kingdom
| | - Aaron P. Roberts
- Transportation Research Group, Boldrewood Innovation Campus, University of Southampton, Southampton, United Kingdom
| | - Katherine L. Plant
- Transportation Research Group, Boldrewood Innovation Campus, University of Southampton, Southampton, United Kingdom
| | - Craig K. Allison
- Transportation Research Group, Boldrewood Innovation Campus, University of Southampton, Southampton, United Kingdom
| | - Catherine Harvey
- Human Factors Research Group, Faculty of Engineering, University of Nottingham, Nottingham, United Kingdom
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8
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Schumacher C, Mössinger E, Min W, Hildebrand F, Frink M. Drowning Injuries: Analysis of a Decennial Air Medical Rescue Center Experience. Air Med J 2016; 35:166-70. [PMID: 27255880 DOI: 10.1016/j.amj.2015.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 11/05/2015] [Accepted: 12/08/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Drowning is one of the leading injury death causes in younger children. Common intensive care measures seem not to improve neurologic outcome, and early prognostic options appear partially unreliable. Therefore, we evaluated a cohort of drowning patients cotreated by a helicopter emergency medical service regarding typical incident constellations, early and subsequent prognostic options, and relevant interventions. METHODS All patients prehospitally cotreated by helicopter emergency medical service "Christoph 4" in primary missions because of drowning incidents during a 10-year period were evaluated. Patient, prehospital, and clinical data were recorded retrospectively; correlations and prognostic values were evaluated with appropriate statistical tests. RESULTS Fifty-one patients were included. Various examination results (several vital, neurologic, and laboratory parameters) and sufficient prehospital first aid measures were significantly correlated with the final outcome (P < .05, respectively). Aspartate aminotransferase and alanine aminotransferase values precisely discriminated between the final outcome groups (P = .001 and area under the receiver operating characteristic curve = 1.0 in both cases). CONCLUSION Aspartate aminotransferase and alanine aminotransferase values were the most useful predictors of outcome in our study. Sufficient prehospital first aid measures were correlated with improved outcome. Regular first aider training is recommended.
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Affiliation(s)
- Carsten Schumacher
- Department of Anaesthesiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany; Helicopter Emergency Medical Service, Hannover Medical School, Hannover, Germany
| | | | - William Min
- Division of Orthopaedic Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Frank Hildebrand
- Helicopter Emergency Medical Service, Hannover Medical School, Hannover, Germany; Department of Trauma and Reconstructive Surgery, University Medical Center Aachen, Aachen, Germany
| | - Michael Frink
- Helicopter Emergency Medical Service, Hannover Medical School, Hannover, Germany; Department for Trauma, Hand and Reconstructive Surgery, University Medical Center Marburg, Marburg, Germany.
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9
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Civilian Helicopter Search and Rescue Accidents in the United States: 1980 Through 2013. Wilderness Environ Med 2015; 26:544-8. [DOI: 10.1016/j.wem.2015.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 08/04/2015] [Accepted: 08/12/2015] [Indexed: 11/22/2022]
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Meadley B, Heschl S, Andrew E, de Wit A, Bernard SA, Smith K. A Paramedic-staffed Helicopter Emergency Medical Service's Response to Winch Missions in Victoria, Australia. PREHOSP EMERG CARE 2015; 20:106-10. [DOI: 10.3109/10903127.2015.1037479] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
BACKGROUND Human activity in wilderness areas has increased globally in recent decades, leading to increased risk of injury and illness. Wilderness medicine has developed in response to both need and interest. METHODS The field of wilderness medicine encompasses many areas of interest. Some focus on special circumstances (such as avalanches) while others have a broader scope (such as trauma care). Several core areas of key interest within wilderness medicine are discussed in this study. RESULTS Wilderness medicine is characterized by remote and improvised care of patients with routine or exotic illnesses or trauma, limited resources and manpower, and delayed evacuation to definitive care. Wilderness medicine is developing rapidly and draws from the breadth of medical and surgical subspecialties as well as the technical fields of mountaineering, climbing, and diving. Research, epidemiology, and evidence-based guidelines are evolving. A hallmark of this field is injury prevention and risk mitigation. The range of topics encompasses high-altitude cerebral edema, decompression sickness, snake envenomation, lightning injury, extremity trauma, and gastroenteritis. Several professional societies, academic fellowships, and training organizations offer education and resources for laypeople and health care professionals. CONCLUSIONS THE FUTURE OF WILDERNESS MEDICINE IS UNFOLDING ON MULTIPLE FRONTS: education, research, training, technology, communications, and environment. Although wilderness medicine research is technically difficult to perform, it is essential to deepening our understanding of the contribution of specific techniques in achieving improvements in clinical outcomes.
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Affiliation(s)
- Douglas G. Sward
- Department of Emergency Medicine, University of Maryland School of Medicine, Hyperbaric Medicine, Shock Trauma Center, Baltimore, Maryland, USA
| | - Brad L. Bennett
- Military & Emergency Medicine Department, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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12
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Carpenter J, Thomas F. A 10-year analysis of 214 HEMS backcountry hoist rescues. Air Med J 2013; 32:98-101. [PMID: 23452369 DOI: 10.1016/j.amj.2012.10.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Revised: 09/07/2012] [Accepted: 10/21/2012] [Indexed: 06/01/2023]
Abstract
BACKGROUND Few published studies on civilian helicopter emergency medical services (HEMS) hoist programs exist. This study provides a demographic analysis of hoist rescue operations performed by the only FAA Part 135 hoist-approved civilian HEMS operator in the United States. METHODS All persons hoisted between May 29, 2001, and May 28, 2011, were retrospectively analyzed. RESULTS Over a 10-year period, 212 of 214 victims were hoisted. The most common indications were fall injuries (38%) and being stranded (21%). Victim demographics showed an average age of 35 ± 17years, predominantly male (79%), often associated with trauma (66%), with a majority (68%) of all victims requiring subsequent transport to a hospital by ground ambulance (24%) or flown by Life Flight (44%). Hoists occurred most often in the afternoon (14:07 ± 3:47 hours), during the weekend (53%), in the months of May-September (71%), at an altitude of 7,488 ± 1487 feet, with the seat harness (39%) being the most common mode of victim extraction. Hoist insertion of search and rescue (SAR) personnel occurred infrequently (5%). CONCLUSION The results from this demographic study on hoist operations can provide important demographic information for HEMS contemplating backcountry hoist operations and programs that interface with SAR agencies.
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Affiliation(s)
- Judi Carpenter
- Intermountain Life Flight, Intermountain Healthcare, Salt Lake City, UT 84116, USA.
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13
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Emergency medical helicopter operations for avalanche accidents. Resuscitation 2012; 84:492-5. [PMID: 22986068 DOI: 10.1016/j.resuscitation.2012.09.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Revised: 09/05/2012] [Accepted: 09/10/2012] [Indexed: 11/20/2022]
Abstract
BACKGROUND In the European Alps emergency medical helicopter services are regularly involved in avalanche rescue missions. How the helicopter emergency medical system best supports avalanche rescue missions is controversial. AIM OF THE STUDY To study advantages and limitations of the early dispatch of emergency medical helicopters after avalanche accidents. METHODS Data on rescue mission characteristics and patterns and severity of medical emergencies were obtained for 221 helicopter avalanche rescue missions performed in the Austrian province of Tyrol between October 2008 and June 2011. RESULTS A buried avalanche victim had to be searched for in only 12 (5.5%) of the 221 rescue missions, whereas medical emergencies were encountered at the scene in 24 missions (11%). Survival rate for totally buried victims extricated after helicopter arrival was significantly lower than for victims extricated before helicopter arrival (19% versus 74%, p=0.0002). In 124 missions (56%) no victim was present at the scene when the helicopter arrived. Medical emergencies involved normothermic cardiac arrest (n=11), severe accidental hypothermia (n=6), critical trauma (n=7) and hypothermia combined with critical trauma (n=1). Survival rate at hospital discharge was 27% for arrested normothermic patients and 50% for trauma and hypothermia patients. CONCLUSIONS Medical emergencies are encountered at avalanche scenes twice as often as there is need to search for totally buried victims, clearly supporting the immediate dispatch of medical crew members to the accident site. The high rate of emergency medical helicopter operations to avalanche incidents where no victim is injured or buried may be characteristic for densely populated mountainous regions and can be reduced by a restrictive dispatch policy after avalanche accidents without clear information about human involvement.
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14
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Pasquier M, Geiser V, De Riedmatten M, Carron PN. Helicopter rescue operations involving winching of an emergency physician. Injury 2012; 43:1377-80. [PMID: 21762912 DOI: 10.1016/j.injury.2011.06.196] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2011] [Revised: 06/22/2011] [Accepted: 06/22/2011] [Indexed: 02/02/2023]
Abstract
OBJECTIVE We sought to study the epidemiologic and medical aspects of alpine helicopter rescue operations involving the winching of an emergency physician to the victim. METHODS We retrospectively reviewed the medical and operational reports of a single helicopter-based emergency medical service. Data from 1 January 2003 to 31 December 2008 were analysed. RESULTS A total of 921 patients were identified, with a male:female ratio of 2:1. There were 56 (6%) patients aged 15 or under. The median time from emergency call to helicopter take-off was 7 min (IQR = 5-10 min). 840 (91%) patients suffered from trauma-related injuries, with falls from heights during sports activities the most frequent event. The most common injuries involved the legs (246 or 27%), head (175 or 19%), upper limbs (117 or 13%), spine (108 or 12%), and femur (66 or 7%). Only 81 (9%) victims suffered from a medical emergency, but these cases were, when compared to the trauma victims, significantly more severe according to the NACA index (p<0.001). Overall, 246 (27%) patients had a severe injury or illness, namely, a potential or overt vital threat (NACA score between 4 and 6). A total of 478 (52%) patients required administration of major analgesics: fentanyl (443 patients or 48%), ketamine (42 patients or 5%) or morphine (7 patients or 1%). The mean dose of fentanyl was 188 micrograms (range 25-750, SD 127). Major medical interventions such as administration of vasoactive drugs, intravenous perfusions of more than 1000 ml of fluids, ventilation or intubation were performed on 39 (4%) patients. CONCLUSIONS The severity of the patients' injuries or illnesses along with the high proportion of medical procedures performed directly on-site validates emergency physician winching for advanced life support procedures and analgesia.
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Affiliation(s)
- M Pasquier
- Emergency Service, University Hospital Center, Lausanne, Switzerland.
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Tomazin I, Vegnuti M, Ellerton J, Reisten O, Sumann G, Kersnik J. Factors impacting on the activation and approach times of helicopter emergency medical services in four Alpine countries. Scand J Trauma Resusc Emerg Med 2012; 20:56. [PMID: 22905968 PMCID: PMC3503609 DOI: 10.1186/1757-7241-20-56] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2012] [Accepted: 08/09/2012] [Indexed: 11/25/2022] Open
Abstract
Background The outcome of severely injured or ill patients can be time dependent. Short activation and approach times for emergency medical service (EMS) units are widely recognized to be important quality indicators. The use of a helicopter emergency medical service (HEMS) can significantly shorten rescue missions especially in mountainous areas. We aimed to analyze the HEMS characteristics that influence the activation and approach times. Methods In a multi-centre retrospective study, we analyzed 6121 rescue missions from nine HEMS bases situated in mountainous regions of four European countries. Results We found large differences in mean activation and approach times among HEMS bases. The shortest mean activation time was 2.9 minutes; the longest 17.0 minutes. The shortest mean approach time was 10.4 minutes; the longest 45.0 minutes. Short times are linked (p < 0.001) to the following conditions: helicopter operator is not state owned; HEMS is integrated in EMS; all crew members are at the same location; doctors come from state or private health institutions; organization performing HEMS is privately owned; helicopters are only for HEMS; operation area is around 10.000 km2; HEMS activation is by a dispatching centre of regional government who is in charge of making decisions; there is only one intermediator in the emergency call; helicopter is equipped with hoist or fixed line; HEMS has more than one base with helicopters, and one team per base; closest neighboring base is 90 km away; HEMS is about 20 years old and has more than 650 missions per year; and modern helicopters are used. Conclusions An improvement in HEMS activation and approach times is possible. We found 17 factors associated with shorter times.
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Affiliation(s)
- Iztok Tomazin
- Mountain Rescue Association of Slovenia, Bleiweissova 34, 4000, Kranj, Slovenia.
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Tomazin I, Ellerton J, Reisten O, Soteras I, Avbelj M. Medical standards for mountain rescue operations using helicopters: official consensus recommendations of the International Commission for Mountain Emergency Medicine (ICAR MEDCOM). High Alt Med Biol 2012; 12:335-41. [PMID: 22206559 DOI: 10.1089/ham.2010.1096] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The purpose of this article is to establish medical recommendations for safe and effective Helicopter Emergency Medical Systems (HEMS) in countries with a dedicated mountain rescue service. A nonsystematic search was undertaken and a consensus among members of International Commission for Mountain Emergency Medicine (ICAR Medcom) was reached. For the severely injured or ill patient, survival depends on approach time and quality of medical treatment by high-level providers. Helicopters can provide significant shortening of the times involved in mountain rescue. Safety is of utmost importance and everything possible should be done to minimize risk. Even in the mountainous environment, the patient should be reached as quickly as possible (optimally<20 min) and provided with on-site and en-route medical treatment according to international standards. The HEMS unit should be integrated into the Emergency Medical System of the region. All dispatchers should be aware of the specific problems encountered in mountainous areas. The nearest qualified HEMS team to the incident site, regardless of administrative boundaries, should be dispatched. The 'air rescue optimal crew' concept with its flexibility and adaptability of crewmembers ensures that all HEMS tasks can be performed. The helicopter and all equipment should be appropriate for the conditions and specific for mountain related emergencies. These recommendations, agreed by ICAR Medcom, establish recommendations for safe and effective HEMS in mountain rescue.
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Affiliation(s)
- Iztok Tomazin
- Mountain Rescue Association of Slovenia, Kranj, Slovenia.
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Vinsonneau U, Cavel C, Bombert C, Lely L, Paleiron N, Vergez-Larrouget C, Cornily JC, Castellant P, Gilard M, Paule P, Bronstein JA. An example of extreme cardiology: chest pain on the high seas and helicoptered medical evacuations: the French Navy experience. Am J Emerg Med 2011; 30:1591-6. [PMID: 22205005 DOI: 10.1016/j.ajem.2011.10.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2011] [Revised: 10/09/2011] [Accepted: 10/10/2011] [Indexed: 11/17/2022] Open
Abstract
Medicalized high sea rescue is very different from prehospital medical evacuation. It requires specifically trained medical teams because the difficulties are marine, aerial, and medically related. The French Navy provides medical evacuations by helicopter on the Atlantic coast, up to 320 km offshore and under all weather conditions. The epidemiology of acute chest pain in the high seas has been poorly described. Therefore, in this retrospective study, we aimed to assess the prevalence and constraints found in the management of these emergencies. From January 1, 2000, to April 30, 2009, 286 medical evacuations by helicopter were performed, 132 of which were due to traumatological emergencies, and 154 to medical emergencies. Acute chest pain, with 36 missions, was the leading cause of medical evacuation. All evacuated patients were men who were either professional sailors or ferry passengers. The median age was 48 years (range, 26-79). The most common prehospital diagnosis was coronary chest pain in 23 patients (64%), including 11 patients with acute coronary syndrome with ST-segment elevation. Thirty-two patients were airlifted by helicopter. All patients benefited from monitoring, electrocardiogram, peripheral venous catheter, and medical management as soon as the technical conditions allowed it.
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Affiliation(s)
- Ulric Vinsonneau
- Clermont Tonnerre Hospital of Military Training, Brest BP41 BCRM 29240 Brest Cedex 9, France.
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Wilderness communications. Wilderness Environ Med 2011; 22:262-9. [PMID: 21723163 DOI: 10.1016/j.wem.2011.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2010] [Revised: 04/12/2011] [Accepted: 05/11/2011] [Indexed: 11/20/2022]
Abstract
When an emergency situation arises in a remote location, the ability to communicate with outside sources of assistance can prove very valuable. This article reviews the different types of communications technologies available to individuals in remote locations, including satellite telephones, personal locator beacons, satellite messengers, cellular telephones, and the different licensed and non-licensed 2-way radio services available for personal use. It also discusses basic radio communications techniques, emergency communication, requesting ground or air casualty evacuation, and selecting communications devices for different applications.
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Repplinger MD, Gangnon RE, Bellazzini MA. Web-based media for landing zone safety instruction. Air Med J 2011; 30:93-96. [PMID: 21382569 PMCID: PMC4139117 DOI: 10.1016/j.amj.2010.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2010] [Revised: 09/02/2010] [Accepted: 10/25/2010] [Indexed: 05/30/2023]
Abstract
INTRODUCTION Crew safety is paramount to successful helicopter emergency medical service transport. This study assesses using an online video to teach landing zone safety. METHODS This is a randomized, prospective study using a 5-minute video to teach landing zone safety. A pre- and post-test were used to assess efficacy of the initial instruction and subsequent knowledge decay. Block randomization by EMS agency or fire department assigned participants to 0, 2, 4, or 6-month post-video testing. RESULTS 257 participants, including 62 EMTs, 114 firefighters, and 80 EMT/firefighters, were enrolled and randomized to immediate (A), 2-month (B), 4-month (C), and 6-month (D) post-video testing. 184 (71.6%) completed the study: A – 72 (93.5%), B – 27 (55.1%), C – 32 (64.0%), and D – 53 (65.4%). Mean scores (pre-test, post-test) were: A – (82.7%, 94.9%), B – (81.9%, 91.2%), C – (86.3%, 88%), and D – (82.6%, 92.2%). Statistically significant score increases were seen in groups A (11.1%, 95% CI 6.0%, 16.1%), B (9.0%, 95% CI 3.1%, 14.9%), and D (9.9%, 95% CI 5.3%, 14.5%). Group C had a mean increase of 2.3%, but this was not statistically significant (p = 0.41). CONCLUSION Web-based media is an effective means of teaching landing zone safety to first responders with minimal knowledge decay.
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Affiliation(s)
- Michael D. Repplinger
- University of Wisconsin School of Medicine and Public Health, Department of Medicine, Division of Emergency Medicine, F2/201 Clinical Science Center, 600 Highland Avenue, Madison, WI 53792, (608) 217-2963 (phone), (608) 262-2641 (fax)
| | - Ronald E. Gangnon
- University of Wisconsin School of Medicine and Public Health, Department of Biostatistics and Medical Informatics
| | - Marc A. Bellazzini
- University of Wisconsin School of Medicine and Public Health, Department of Medicine, Division of Emergency Medicine
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Vinsonneau U, Bombert C, Brondex A, Castellant P, Cornily JC, Pennec PY, Cavel C, Vergez-Larrouget C, Perchoc S, Castellant M, Godon P, Blanc JJ, Quiniou G. [Acute heart disease in search and rescue helicopter missions, from French Navy. A retrospective study from 2000 to 2007]. Ann Cardiol Angeiol (Paris) 2009; 58:197-202. [PMID: 19467644 DOI: 10.1016/j.ancard.2009.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2008] [Accepted: 02/20/2009] [Indexed: 05/27/2023]
Abstract
BACKGROUND Search and rescue helicopters from the French navy conduct ambulance and search and rescue missions near the western coast of the French Britain. The team on board includes military doctor and paramedic. Operations in this area are challenging due to long distances and severe weather conditions. METHODS We studied retrospectively 205 search and rescue missions from 2000 to 2007 with special emphasis on acute heart disease and operative conditions. RESULTS 12.2% of the missions (25/205) concern acute heart disease dominated by myocardial infarction elevation myocardial infarction. All of the patients are male. Most of them are seafarers and the others come from ferries with a median age of 53.4 years. Sixty-two percent of the missions were carried in darkness. The median range is about 80 nautical miles. Two patients died during search and rescue missions. All patient are hospitalized. CONCLUSION Ambulance and search and rescue mission near the western coasting of the French Britain are a challenge. Using a heavy helicopter from French Navy was the best way to carry medical treatment to seafarers and passengers of ferries suffering from acute heart disease.
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Affiliation(s)
- U Vinsonneau
- Service de cardiologie, hôpital d'Instruction des Armées-Clermont-Tonnerre, rue Colonel-Fonferrier, 29240 Brest Armées, France.
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