Helicopter Hoist Operations in Difficult Nonalpine Terrain

OBJECTIVE

Helicopter hoist operations (HHOs) are an option for rescue in difficult- or impossible-to-access environments. At present, only a few helicopters in German helicopter emergency medical services have a hoist capability; most of them are located in the Bavarian Alps. We sought to study the demand for hoist operations in difficult terrain outside of alpine regions.

METHODS

The setting for this study was a city borough between the Rhine valley and the Black Forest (Germany). We retrospectively studied all rescue operations in difficult terrain from January 1, 2007, to July 31, 2018. The characteristics of the terrain and operational, demographic, and medical aspects were analyzed. The predictors for a prolonged response time and the total prehospital time were identified by multivariate regression analysis. In addition, a simulation study creating time intervals for the alternative rescue procedure (ground vs. hoist) was performed. Operational data for the simulation were taken from an expert survey as well as field data collection in the course of HHO training.

RESULTS

A total of 251 missions were included. Patients were predominantly male (66.7%) adults (57.5%) with traumatic lesions (75.0%); 14.1% had severe or multiple injuries, 4.7% had life-threatening medical conditions, and 4.3% were deceased. Two hundred eight patients (93%) were rescued by ground procedures. The prehospital time of HHO missions was significantly longer (104 vs. 72 minutes, P < .001). However, the simulation of all missions showed a significantly shorter prehospital time with 80 versus 91 minutes (P < .001) for rescue by HHOs. The predictors for prolonged prehospital times were a vague description of the accident site, difficult terrain, distance from the road, slope gradient, and life-threatening nontraumatic conditions of the patient.

CONCLUSION

We found a significant benefit of hoist operations regarding the total prehospital time and admission to an appropriate trauma center. Consistent dispatch procedures for HHO missions can improve patient outcomes. Adding HHO capabilities to some selected helicopter emergency medical service helicopters should be considered.

Advanced Ventilation and Monitoring During Helicopter Hoist Extraction of an Intubated Patient

The intubated and ventilated patient in austere and inaccessible environments requiring helicopter hoist extraction presents significant procedural and logistical challenges. This case report describes the use of a mechanical ventilator and visible advanced monitoring throughout the entirety of the patient journey from the prehospital scene to the hospital, including the period during hoist extraction as human external cargo.

Emergency Care Provided by the Israeli Military Airborne Combat Evacuation Unit during Helicopter Winch Rescue Operations

OBJECTIVES

The objective of this study was to evaluate the emergency care provided by the Israeli Military Airborne Combat Evacuation Unit (MACEU) during helicopter winching operations. Methods: A retrospective cohort study was performed of all patients rescued by winching by the MACEU between December 2011 and October 2018. Data were extracted from the electronic medical records of the unit registry. The data collected included helicopter type, scene times, demographics, mechanism of injury, interventions, medications, and survival. Results: During the study period, 208 civilians with a mean age of 36.8 ± 19.2 years were evacuated from inaccessible areas, 192 were from difficult terrain, 10 from sea vessels, and 5 from floods. All patients were winched up with a crewmember. No patient or crewmember was injured during winching. Overall, 156/208 (75%) had a traumatic injury, and 52/208 (25%) had a medical emergency. Sikorsky UH-60 "BlackHawk" helicopters and Sikorsky CH-53 "Sea Stallion" helicopters were used in 179 and 28 operations, respectively. Eighteen different procedures were performed by the medical personnel of the unit on scene and en route. The most performed procedures were peripheral vascular access establishment (60.6%), fluids administration (57.7%), oxygen supplementation (42.8%), analgesia (39.9%) and spine immobilization (37.5%). On scene, none of the patients was treated with a physician-only intervention. Thirty/208 (14.5%) patients were winched-up in darkness conditions. Eleven/208 (5.3%) apneic breathing patients were winched up ventilated by a crewmember. All the six patients who had oxygen saturation ≥89% after entrance into the cabin, survived. Conclusions: The reported MACEU experience provides useful information on the clinical characteristics, medical interventions, and outcomes of patients rescued using a winching operation. Study findings emphasize the importance of airway management and ventilation during winching.

Unattended Hoist Extraction of an Intubated Patient From Mountainous Terrain

Airway management and maintenance of adequate ventilation during a patient's unattended helicopter rescue hoist extraction present unique challenges to the air medical provider. We present the case of a critically injured patient requiring emergent airway management and subsequent extrication via hoist from challenging, near-vertical terrain, which illustrates the logistical challenges of providing high-quality, neuroprotective mechanical ventilation in an austere air medical scenario.

Ventilation of intubated patients during HEMS hoisting operations

In response to the review “Advanced airway management in hoist and longline operations in mountain HEMS - considerations in austere environments: a narrative review.” by Pietsch et al. we refer to recently published original research describing manual versus automatic ventilation of intubated patients during helicopter hoisting operations.