On-site hospital helipads: resource document for the NAEMSP position paper on on-site hospital helipads

Impact of a ground intermediate transport from the helicopter landing site at a hospital on transport duration and patient safety

BACKGROUND

Helicopter emergency medical service provides timely care and rapid transport of severely injured or critically ill patients. Due to constructional or regulatory provisions at some hospitals, a remote helicopter landing site necessitates an intermediate ground transport to the emergency department by ambulance which might lengthen patient transport time and comprises the risk of disconnection or loss of vascular access lines, breathing tubes or impairment of other relevant equipment during the loading processes. The aim of this study was to evaluate if a ground intermediate transport at the hospital site prolonged patient transport times and operating times or increases complication rates.

METHODS

A retrospective analysis of all missions of a German air rescue service between 2012 and 2020 was conducted. Need of a ground transport at the accepting hospital, transfer time from the helipad to the hospital, overall patient transport time from the emergency location or the referring hospital to the accepting hospital and duration of the mission were analyzed. Several possible confounders such as type of mission, mechanical ventilation of the patient, use of syringe infusion pumps (SIPs), day- or nighttime were considered.

RESULTS

Of a total of 179,003 missions (92,773 (51,8%) primary rescue missions, 10,001 (5,6%) polytrauma patients) 86,230 (48,2%) secondary transfers) an intermediate transport by ambulance occurred in 40,459 (22,6%) cases. While transfer times were prolonged from 6.3 to 8.8 min for primary rescue cases (p < 0.001) and from 9.2 to 13.5 min for interhospital retrieval missions (p < 0.001), the overall patient transport time was 14.8 versus 15.8 min (p < 0.001) in primary rescue and 23.5 versus 26.8 min (p < 0.001) in interhospital transfer. Linear regression analysis revealed a mean time difference of 3.91 min for mechanical ventilation of a patient (p < 0.001), 7.06 min for the use of SIPs (p < 0.001) and 2.73 min for an intermediate ambulance transfer (p < 0.001). There was no relevant difference of complication rates seen.

CONCLUSIONS

An intermediate ground transport from a remote helicopter landing site to the emergency department by ambulance at the receiving hospital had a minor impact on transportation times and complication rates.

An Approved Landing Site (ALS) improves the logistics of interhospital transfer of critically ill patients by helicopter

The COVID-19 pandemic limited hospital resources and necessitated interhospital transport of ICU-patients in order to provide critical care to all patients in the Netherlands. However, not all hospitals have an approved landing site. The ICU-transport operation was executed under HEMS-license and landing on non-aerodrome terrain was permitted. This allowed the search for an ad-hoc landing site in the direct vicinity of the ICU. The following characteristics were judged: slope, obstacles, size, soil conditions and the presence of foreign objects.

Before the start of this transport operation, in two days, all hospitals in the Netherlands were visited and presumed landing sites explored, described, photographed and recorded in the electronic flight bag. At 71 (87,6 %) of the hospitals it was possible to install a temporary approved landing site in the direct vicinity of the ICU. 110 landings were made on these landing sites and 114 landings on approved heliports. Only 11 patients required secondary transport to or from the helicopter landings site. This occurred only in two patients from a heliport to a receiving hospital.

The construction of pre-explored approved landing sites in the vicinity of hospitals allows safe transportation of patients by helicopter to hospitals without a heliport.

Helicopter Transportation of Brazilian Trauma Patients: A Comparison of Times to Care

OBJECTIVE

The purpose of this study was to analyze helicopter emergency medical service (HEMS) transport with secondary land ambulance transfer, comparing landings performed inside and outside the hospital complex to the emergency department.

METHODS

This was a cross-sectional observational study of HEMS transports of trauma patients between 2016 and 2018 in southern Brazil. Patients were attended by the HEMS team at the trauma site or stabilized in hospitals nearby and subsequently referred to trauma centers. In this region, no trauma centers have their own helipads so helicopters land in remote areas close to the hospital, which may be inside or outside the hospital complex. Both landings require ground emergency medical service transport, with off-site landings necessitating ground emergency medical service transport via public access roads to reach the hospital. Data were analyzed using descriptive statistics, and on-site and off-site transport times were compared using a t-test for independent samples.

RESULTS

Of 176 transports, 28.5% resulted in on-site landings, whereas 71.5% occurred off-site. The ground transport time when the landing zone was off-site was 5 minutes longer than on-site (P < .001).

CONCLUSION

Off-site landings result in longer transports to the emergency room. The construction of helipads in trauma centers can reduce transport time, in addition to reducing the costs and sequelae of trauma.

Geographic information software programs' accuracy for interfacility air transport distances and time

INTRODUCTION

This study aimed to evaluate consistency/predictability of interfacility flight times (IFFTs) and accuracy of geographical information system (GIS) software packages for estimating IFFT.

METHODS

This retrospective study conducted by a program using a Bell 206 assessed the first 1000 IF transports occurring on 137 "runs" (ie, referring-receiving hospital pairings) made at least twice. GIS IFFT estimates using Google Earth™ (GE) and ArcGIS™ (AG) were compared against actual IFFT using linear regression; univariate analysis included assessment of medians with 95% binomial exact confidence intervals (CIs). Interrater agreement for GIS was assessed with κ.

RESULTS

GE and AG estimates fell, respectively, within 1 mile of actual in 136/137 runs (99%, 95% CI 96%-100%) and 130/137 runs (95%, 95% CI 90%-98%). GE- and AG-predicted IFFT strongly (P < .001) correlated with, underestimating by about 2 minutes, actual IFFT (GE: r2 0.93, coefficient 0.98, 95% CI .97-1.00; AG: r2 0.93; coefficient 0.98, 95% CI .96-1.0). GE and AG had statistically equivalent (κ > .8), "almost-perfect," interrater agreement.

CONCLUSION

IFFTs for same-run helicopter EMS transports in our rural state setting are characterized by little variability. GIS is highly accurate in predicting IF logistics, with public-domain GE performing as well as more expensive AG.

Helicopter transport effectiveness of patients for primary percutaneous coronary intervention

BACKGROUND

For patients with ST-elevated myocardial infarction (STEMI), time to primary percutaneous coronary intervention (PCI) is an important factor in saving myocardium. Helicopter emergency medical service (HEMS) has become a vital component in regionalized cardiac care. The objective of this study is to assess the logistics of HEMS and ground EMS for interfacility transport of STEMI patients for primary PCI and to determine the effectiveness of HEMS transports in terms of the number of lives saved per 100 flights.

METHODS

This is a retrospective database and records review of interfacility transports of STEMI patients for primary PCI to a single medical center. The study period consisted of 18 months (January 2010 through June 2011).

RESULTS

Ninety-seven of 120 patients met the criteria for review. Of these, 66% were transported by HEMS. The pretransport patient handling times were similar for the HEMS and ground EMS groups. Door-to-PCI in < 120 minutes was achieved in 35.5% (11 of 31) of ground EMS and 24.2% (16 of 66) of HEMS. Patients transported by ground EMS were more likely to get to PCI in < 90 minutes (9.7%, 3 of 31). HEMS patients traveled significantly farther distances, 51 miles (IQR 43-68) than ground EMS, 37 miles (IQR 18-51). This equates to a 38% longer distance for patients transported by HEMS. An estimate of the driving time for HEMS-transported patients suggests HEMS transports saved a median of 41 minutes (IQR 33-48). The proportion of HEMS flights saving more than 30 minutes was 78.8% (95% CI 67.0-87.9%).

CONCLUSION

The results did not show a time savings for HEMS- versus ground EMS-transported patients. When estimates of time spent for ground EMS of actual HEMS transported patients are analyzed, HEMS provides a median savings of 41 minutes, with a savings of at least 30 minutes in 78.8% of the HEMS patients. Based on estimates used in this study, conservative calculations arrived at a time-based mortality effectiveness of HEMS of about 1.2 lives saved per 100 flights.