Search and Rescue and Remote Medical Evacuation in a Norwegian Setting: Comparison of Two Systems

Permissive hypoventilation equally effective to maintain oxygenation as positive pressure ventilation after porcine class III hemorrhage and whole blood resuscitation

BACKGROUND

Prehospital anesthesia may lead to circulatory collapse after severe hemorrhage. It is possible that permissive hypoventilation, refraining from tracheal intubation and accepting spontaneous ventilation, decreases this risk, but it is not known if oxygen delivery can be maintained. We investigated the feasibility of permissive hypoventilation after class III hemorrhage and whole blood resuscitation in three prehospital phases: 15 min on-scene, 30 min whole blood resuscitation, and 45 min after.

STUDY DESIGN AND METHODS

19 crossbred swine, mean weight 58.5 kg, were anesthetized with ketamine/midazolam and hemorrhaged to a mean (SD) 1298 (220) mL (33%) and randomized to permissive hypoventilation (n = 9) or positive pressure ventilation with FiO2 21% (n = 10).

RESULTS

In permissive hypoventilation versus positive pressure ventilation, indexed oxygen delivery (DO2 I) decreased to mean (SD) 4.73 (1.06) versus 3.70 (1.13) mL min-1  kg-1 after hemorrhage and increased to 8.62 (2.09) versus 6.70 (1.56) mL min-1  kg-1 at completion of resuscitation. DO2 I, indexed oxygen consumption (VO2 I), and arterial saturation (SaO2 ) did not differ. Permissive hypoventilation increased the respiratory rate and increased pCO2 . Positive pressure ventilation did not deteriorate circulation. Cardiac index (CI), systolic arterial pressure (SAP), hemoglobin (Hb), and heart rate did not differ.

DISCUSSION

Permissive hypoventilation and positive pressure ventilation were equally effective to maintain oxygen delivery in all phases. A respiratory rate of 40 was feasible, showing no signs of respiratory fatigue for 90 min, indicating that whole blood resuscitation may be prioritized in select patients with severe hemorrhage and spontaneous breathing.

Static Rope Rescue Operations in Western Norway: A Retrospective Analysis of 141 Missions

INTRODUCTION

The Norwegian national standard for rescuers describes medical and rescue requirements for helicopter emergency medical services (HEMS) technical crew members, but there is a lack of scientific data supporting these requirements and their safety relevance. The study aims to analyze the rescue profile of Norwegian HEMS static rope human external cargo operations, emphasizing terrain challenges and additional safety measures utilized on-site.

METHODS

We conducted a retrospective descriptive analysis of static rope missions performed in daylight by 3 HEMS bases in Western Norway in the period 2015 to 2019. The analysis measures evacuation methods, terrain, on-site safety measures, and medical treatment.

RESULTS

Out of 8352 primary HEMS and search and rescue missions, a total of 141 (2%) static rope missions were performed by the 3 HEMS bases in Western Norway. The most commonly used evacuation method was triangle harness (62%) and a static rope length of 30 m (81%). Ninety-two (65%) missions were completed in simple terrain, 38 (27%) in challenging terrain, and 11 (8%) in complex terrain. There were no reported accidents, but a small number of adverse events were registered. The most frequent medical intervention administered on-site was pain management, followed by spinal immobilization.

CONCLUSIONS

Thirty-five percent of the static rope missions performed by HEMS in Western Norway were completed in challenging or complex terrain, requiring additional safety measures on-site. The most common safety measure needed was the ability to operate in a mountain or alpine environment. Our findings support the safety relevance of a national standard for rescuers.

Posttraumatic Stress Responses and Psychological Well-being in Norwegian Medical Helicopter Personnel

OBJECTIVE

Emergency medical personnel are exposed to multiple stressors, including those of psychological etiologies. The aim of this study was to report the prevalence of anxiety, depression, and posttraumatic stress symptoms in Norwegian medical helicopter personnel and to determine to what degree they report personal growth or deprecation due to exposure to work-related events.

METHODS

This was a web-based, cross-sectional survey performed among rescue paramedics and physicians staffing helicopter emergency medical services and search and rescue helicopters between May 5, 2021, and July 5, 2021. Questions included demographic data, the traumatic events exposure index, the Generalized Anxiety Disorder 7 scale, the Patient Health Questionnaire 9 (Depression), the posttraumatic change scale, and the posttraumatic symptom scale.

RESULTS

Of the 245 eligible participants, 10 declined to take part and 74 failed to answer, producing a response rate of 66% (72 rescue paramedics and 89 physicians). Of the study population, 3.9 % reported manifest posttraumatic stress disorder symptoms, and 1.9% described moderate to severe depression and anxiety. The majority (76%) described posttraumatic emotional growth because of their work experience.

CONCLUSION

Despite exposure to several traumatic stressors, participants reported a lower prevalence of posttraumatic stress symptoms, depression, and anxiety compared with a Norwegian adult population.

Search and Rescue Helicopters for Emergency Medical Service Assistance: A Retrospective Study

OBJECTIVE

The time until treatment is a crucial factor for the outcome after medical emergencies. One way of reducing transportation time is the use of helicopter-based emergency medical services, but poor weather conditions, commitment to another mission, or technical problems may limit the availability. In these cases, military search and rescue (SAR) helicopters can be used. The aim of this study was to investigate the role of SAR helicopters in the civilian emergency medical system.

METHODS

We conducted a retrospective study of SAR mission reports and SAR medical records collected from the archives of the Royal Danish Air Force for the years 2016 and 2017.

RESULTS

A total of 1,262 mission reports were included with a total of 628 medical records available in the study period. There were 490 of 1,246 (39.3%) missions involving patients. Interhospital transfers accounted for 306 of 604 (50.7%) of cases, whereas island evacuation constituted 110 of 604 (18.2%) cases. The most prevalent suspected diagnosis was acute coronary syndrome (14.4%). The 30-day survival rate was 87.6%.

CONCLUSION

The military SAR helicopters were most commonly activated for civilian emergency medical service mission assistance due to poor weather conditions. The most frequent medical condition was acute coronary syndrome.

Prehospital Stressors: A Cross-sectional Study of Norwegian Helicopter Emergency Medical Physicians

OBJECTIVE

Personnel working in helicopter emergency medical services (HEMS) and search and rescue (SAR) are exposed to environmental stressors, which may impair performance. The aim of this survey was to study the extent HEMS and SAR physicians report the influence of specific danger-based and non-danger-based stressors.

METHODS

The study was performed as a cross-sectional, anonymous, Web-based (Questback AS, Bogstadveien 54, 0366 Oslo, Norway) survey of Norwegian HEMS and SAR physicians between December 2, 2019, and February 25, 2020.

RESULTS

Of the recipients, 119 (79.3%) responded. In helicopter operations, 33.6% (n = 40) reported involvement in a minor accident and 44.5% (n = 53) a near accident. In the rapid response car, 26.1% (n = 31) reported near accidents, whereas 26.9% (32) reported this in an ambulance. Of physicians, 20.2% (n = 24) received verbal abuse or threats during the last 12 months. When on call, 50.4% (n = 60) of physicians reported sometimes or often being influenced by fatigue.

CONCLUSION

This study shows that Norwegian HEMS and SAR physicians are exposed to several stressors of both a danger-based and non-danger-based nature, especially regarding accidents, threatening patient behavior, and fatigue. Very serious incidents appear to be seldom, and job satisfaction is high.