The mission characteristics of a newly implemented rural helicopter emergency medical service

Helicopter emergency medical services in Eastern Iran: a 4-year cross-sectional study of time intervals and mission profiles

BACKGROUND

Air medical transport services play a significant role in emergency situations by providing timely transfers of critically ill patients to medical facilities. This study aimed to investigate the mission characteristics of helicopter emergency medical services (HEMS) and the associated time intervals in a geographically remote region of eastern Iran. We also compared the prehospital times of HEMS and ground transportation to determine whether dispatching a helicopter is time-efficient.

METHODS

This retrospective cross-sectional study was conducted at the prehospital emergency medical center in Gonabad, a remote area in eastern Iran. Data were collected using standardized electronic forms developed by the Ministry of Health and Medical Education (MOHME) in Iran. We analyzed the mission profiles and prehospital time intervals for all Gonabad HEMS missions conducted between 2021 and 2024. The mean activation time was compared to the national benchmark of three minutes, and the prehospital time intervals of air ambulances were compared to those of ground ambulances.

RESULTS

From 2021 to 2024, there were 252 HEMS missions, transporting 265 patients. Of all 252 missions, 95 (37.7%) were primary missions, and 157 (62.3%) were secondary missions. The most frequent reasons for air ambulance dispatch were trauma, acute coronary syndrome, and strokes. The mean ± SD for HEMS activation time was 9.14 ± 3.63 min, significantly exceeding the national benchmark of three minutes. HEMS prehospital time was 49.73 ± 9.67 min. The comparison of prehospital time intervals indicated that air emergency services are more time-efficient than ground ambulances.

CONCLUSION

This study found that the mean activation time of air ambulances exceeded the national benchmark of three minutes. When comparing prehospital times for air ambulance and ground ambulance services, HEMS was faster than both ground scenarios. The current benchmark for helicopter activation time in Iran may need clarification and revision.

Helicopter emergency medical services in Iceland between 2018 and 2022-A retrospective study

BACKGROUND

Helicopter emergency services (HEMS) are widely used to bring medical assistance to individuals that cannot be reached by other means or individuals that have time-critical medical conditions, such as chest pain, stroke or severe trauma. It is a very expensive resource whose use and importance depends on local conditions. The aim of this study was to describe flight and patient characteristics in all HEMS flights done in Iceland, a geographically isolated, mountainous and sparsely populated country, over a 5-year course.

METHODS

This retrospective study included all individuals requiring HEMS transportation in Iceland during 2018-2022. The electronic database of the Icelandic Coast Guard was used to identify the individuals and register flight data. Electronic databases from Landspitali and Akureyri hospitals were used to collect clinical variables. Descriptive statistics was applied.

RESULTS

The average number of HEMS transports was 3.5/10,000 inhabitants and the median [IQR] activation time and flight times were 30 min [20-42] and 40 min [26-62] respectively. The vast majority of patients were transported to Landspitali Hospital in Reykjavik. More than half of the transports were due to trauma, the most common medical transports were due to chest pain or cardiac arrests. Advanced medical therapy was provided for 66 (10%) of individuals during primary transports, 157 (24%) of individuals were admitted to intensive care, 188 (28%) needed surgery and 53 (7.9%) needed a coronary angiography.

CONCLUSION

In Iceland, the number of transports is lower but activation and flight times for HEMS flights are considerably longer than in other Nordic countries, likely due to geographical features and the structure of the service including utilizing helicopters both for HEMS and search and rescue operations. The transport times for some time-sensitive conditions are not within standards set by international studies and guidelines.

Optimizing remote and rural prehospital resources using air transport of thrombectomy candidates

BACKGROUND

In Finland, the yearly number of mechanical thrombectomies for acute stroke is increasing and more patients are transported over 100 km to the comprehensive stroke centre (CSC) for definitive care. This leaves the rural townships without immediate emergency medical services (EMS) for hours. In this study we compare the EMS' estimated return times to own station after the handover of a thrombectomy candidate between two transport methods: (1) using ground transportation with an ambulance to the CSC or (2) using a hydrid strategy starting the transportation with an ambulance and continuing by air with a helicopter emergency medical services unit (HEMS).

METHODS

We reviewed retrospectively all thrombectomy candidates' transportations from the hospital district of South Ostrobothnia to definitive care at the nearest CSC, Tampere University Hospital from June 2020 to October 2022. The dispatch protocol stated that a thrombectomy candidate's transport begins immediately with an ambulance and if the local HEMS unit is available the patient is handed over to them at a rendezvous. If not, the patient is transported to the CSC by ground. Transport times and locations of the patient handovers were reviewed from the CSC's EMS database and the driving time back to ambulance station was estimated using Google maps. The HEMS unit's pilot's log was reviewed to assess their mission engagement time.

RESULTS

The median distance from the CSC to the ambulances' stations was 188 km (IQR 149-204 km) and from the rendezvous with the HEMS unit 70 km (IQR 51-91 km, p < 0.001). The estimated median driving time back to station after the patient handover at the CSC was 145 min (IQR 117-153 min) compared to the patient handover to the HEMS unit 53 min (IQR 38-68 min, p < 0.001). The HEMS unit was occupied in thrombectomy candidate's transport mission for a median of 136 min (IQR 127-148 min).

CONCLUSION

A hybrid strategy to transport thrombectomy candidates with an ambulance and a helicopter reallocates the EMS resources markedly faster back to their own district.

Characteristics of the most severely ill and injured patients in a Norwegian helicopter emergency medical service: a retrospective cohort study

BACKGROUND

Physician-staffed helicopter emergency medical services (HEMS) are dispatched to a variety of incidents, ranging from less serious to life-threatening. The skillset of a physician may be important to provide appropriate care for the most critically ill and severely injured patients. A better understanding of these patients may therefore be important to optimize dispatch criteria, training, and equipment setups for HEMS units. The aim of this study was to describe the characteristics of patients with the national advisory committee on aeronautics (NACA) score 5 and 6, primarily by diagnostic group and interventions performed.

METHODS

Retrospective cohort study on aggregated data from the HEMS-base in Trondheim, Norway. All patients with NACA score 5 and 6 in the 10-year period from 2013 to 2022 were included. Patients with return of spontaneous circulation (ROSC) after successful cardiopulmonary resuscitation were described separately from non-cardiac arrest patients.

RESULTS

Out of 9546 patient encounters, 2598 patients were included, with 1640 in the NACA 5 and 958 in NACA 6 group. Patient age was median 63 (interquartile range 45-74) and 64% of the patients were male. Post-ROSC patients accounted for 24% of patients. Of the non-cardiac arrest patients, the most frequent aetiology was trauma (16%), cardiac (15%), neurologic (14%) and respiratory (11%). The most common physician-requiring advanced interventions were general anaesthesia (22%), intubation (21%), invasive blood pressure monitoring (21%) and ventilator treatment (18%). The mean number of advanced interventions per mission were consistent during the study period (1,78, SD 0,25).

CONCLUSION

Twenty-seven percent of all HEMS dispatches were to NACA 5 and 6 patients. Twenty-four percent of these were post-ROSC patients. Sixty-three percent of all patients received at least one advanced physician-requiring intervention and the average number of interventions were consistent during the last 10 years. Hence, the competence a physician-staffed HEMS resource provide is utilized in a high number of critically ill and injured patients.

Trauma patient transport to hospital using helicopter emergency medical services or road ambulance in Sweden: a comparison of survival and prehospital time intervals

BACKGROUND

The benefits of helicopter emergency medical services (HEMS) transport of adults following major trauma have been examined with mixed results, with some studies reporting a survival benefit compared to regular emergency medical services (EMS). The benefit of HEMS in the context of the Swedish trauma system remains unclear.

AIM

To investigate differences in survival and prehospital time intervals for trauma patients in Sweden transported by HEMS compared to road ambulance EMS.

METHODS

A total of 74,032 trauma patients treated during 2012-2022 were identified through the Swedish Trauma Registry (SweTrau). The primary outcome was 30-day mortality and Glasgow Outcome Score at discharge from hospital (to home or rehab); secondary outcomes were the proportion of severely injured patients who triggered a trauma team activation (TTA) on arrival to hospital and the proportion of severely injured patients with GCS ≤ 8 who were subject to prehospital endotracheal intubation.

RESULTS

4529 out of 74,032 patients were transported by HEMS during the study period. HEMS patients had significantly lower mortality compared to patients transported by EMS at 1.9% vs 4.3% (ISS 9-15), 5.4% vs 9.4% (ISS 16-24) and 31% vs 42% (ISS ≥ 25) (p < 0.001). Transport by HEMS was also associated with worse neurological outcome at discharge from hospital, as well as a higher rate of in-hospital TTA for severely injured patients and higher rate of prehospital intubation for severely injured patients with GCS ≤ 8. Prehospital time intervals were significantly longer for HEMS patients compared to EMS across all injury severity groups.

CONCLUSION

Trauma patients transported to hospital by HEMS had significantly lower mortality compared to those transported by EMS, despite longer prehospital time intervals and greater injury severity. However, this survival benefit may have been at the expense of a higher degree of adverse neurological outcome. Increasing the availability of HEMS to include all regions should be considered as it may be the preferrable option for transport of severely injured trauma patients in Sweden.

Overcoming distance: an exploration of current practices of government and charity-funded critical care transport and retrieval organizations

BACKGROUND

For critically ill and injured patients, timely access to definitive care is associated with a reduction in avoidable mortality. Access to definitive care is significantly affected by geographic remoteness. To overcome this disparity, a robust critical care transport (CCT) or retrieval system is essential to support the equity of care and overcome the tyranny of distance. While critical care transport or retrieval systems have evolved over the years, there is no universally accepted system or standard, which has led to considerable variation in practices. The objective of this mixed-methods study was to identify and explore the current clinical, operational, and educational practices of government and charity-funded critical care transport and retrieval organizations operating across access- and weather- challenged geography.

METHODS

This study utilized a mixed-methods approach comprising a rapid review of the literature and semi-structured interviews with identified subject matter experts (SME).

RESULTS

A total of 44 articles and 14 interviews with SMEs from six different countries, 12 different services/systems, and seven operational roles, including clinicians (physician, paramedic, and nurse), educator, quality improvement, clinical governance, clinical informatics and research, operations manager, and medical director were included in the narrative analysis. The study identified several themes including deployment, crew composition, selection and education, clinical governance, quality assurance and quality improvement and research.

CONCLUSION

This mixed-methods study underscores the paucity of literature describing current clinical, operational, and educational practices of government or charity-funded CCT or retrieval programs operating across access- and weather- challenged geography. While many common themes were identified including clearly defined mission profiles, use of dedicated or specialized transport teams, central coordination, rigorous selection processes, service-sponsored graduate education, and strong clinical governance, there is little consensus and considerable variation in current practices. Further research is needed to identify and harmonize best practices within the CCT and retrieval environments.

Helicopter Ambulance Transport to the Emergency Department: Demographic and Clinical Factors Impacting Outcomes in a Turkish Medical Center

BACKGROUND Helicopter ambulances (HAs) are a significant component of pre-hospital emergency medical services. This study presents a report on the demographic and clinical factors associated with transport to the emergency department (ED) by HA of 161 patients to a single center in Turkey. MATERIAL AND METHODS Demographic data, diagnoses in arriving center's ED, transferred distance, and outcomes of 161 patients transferred by HAs between March 01, 2019 and May 31, 2021 were retrospectively evaluated. Mortality rates of the cases were compared both with age and according to the distance traveled within the diagnostic groups. RESULTS There were 134 patients (83.2%) with internal diseases, and cardiovascular diseases were the leading cause (68 patients, 41.6%); 27 patients (16.7%) were transferred due to trauma. The mean distance traveled with HAs was 167.1 km (range, 47.0-1316.0) and the median transfer time was 50 min. The most common form of hospitalization after ED arrival was intensive care hospitalization (n=78, 48.4%). Mortality increased as the transfer distance increased in elderly patients, as well as those with a cardiac or trauma-related diagnosis (P=0.015, P=0.044, P=0.028, respectively). CONCLUSIONS Most patients transferred by HA had severe disease. ED physicians dealing with patient transfer by HAs should be prepared for severe cases, both in the HA and in the ED. HAs may be preferred when making the transfer decision for elderly patients, trauma patients, and those with cardiac disease.

Physician-staffed prehospital units: a retrospective follow-up from an urban area in Scandinavia

BACKGROUND

The aim of this study was to determine when and how rapid response vehicles (RRVs) make a difference in prehospital care by investigating the number and kinds of RRV assignment dispatches and the prehospital characteristics and interventions involved.

METHODS

This retrospective cohort study was based on data from a quality assurance system where all assignments are registered. RRV staff register every assignment directly at the site, using a smartphone, tablet, or computer. There is no mandatory information requirement or time limit for registration. The study includes data for all RRVs operating in Region Stockholm, three during daytime hours and one at night - from January 1, 2021 to December 31, 2021.

RESULTS

In 2021, RRVs in Stockholm were dispatched on 11,283 occasions, of which 3,571 (31.6%) resulted in stand-downs. In general, stand-downs were less common for older patients. The most common dispatch category was blunt trauma (1,584 or 14.0%), which accounted for the highest frequency of stand-downs (676 or 6.0%). The second most common category was cardiac arrest (1,086 or 9.6%), followed by shortness of breath (691 or 6.1%), medical not specified (N/S) (596 or 5.3%), and seizures (572 or 5.1%).

CONCLUSION

The study findings confirm that RRVs provide valuable assistance to the ambulance service in Stockholm, especially for cardiac arrest and trauma patients. In particular, RRV personnel have more advanced medical knowledge and can administer medications and perform interventions that the regular ambulance service cannot provide.

The Development of Helicopter Emergency Medical Services in the Republic of Ireland

Helicopter emergency medical services (HEMS) have formed an integral component of the Irish health care system for the past decade; yet, the factors leading their commencement, their evolutions over this time, and the current model of service delivery have not been widely published. Aeromedical service provision may vary significantly from country to country and may also vary regionally within countries. A health system's necessities; capacity and maturity; the level of state, corporate, private, or community investment; and the capacity of the contracted service provider are all factors that influence the service provision. This research article describes the historic factors leading to a military and health system collaboration to HEMS during an era of health care reform. Over the past decade, the Irish health system has undergone significant reconfiguration and centralization of services, leading to increased demands on emergency medical ground and air medical services. Future advancements in aeromedical service provision require an innate understanding of the current model. This article adds to the knowledge base, informs policy makers, and supports decision making surrounding HEMS provision and the potential to explore military and health system collaborations and enhanced overall service provision.

Challenges of prehospital aerial operations in response to earthquake hazards: A qualitative study

BACKGROUNDS

Due to the severity of the earthquake, it may need immediate treatment and transfer of the injured people to advanced medical centers, as well as dispatch of the expert team and specialized health equipment to the accident-affected area. Aerial emergency is an important responsibility of the health care system in this situation. The study aimed to extract the prehospital emergency challenges of Iran aerial operations emergency in response to the earthquake.

MATERIALS AND METHODS

The study was qualitative content analysis with conventional approach. Sampling was done in a purposive method and data were collected through semi-structured interview. The panel involved consists of 26 health professionals in medical emergencies. Recorded interviews were transcribed into written and then conventional content analysis was used to derive coding categories directly from the text data.

RESULTS

Content analysis is provided 97 initial codes, 20 subcategories and 4 main categories including challenges of "response assessment," "support," "pre-hospital staff-management," and "response operation," respectively.

CONCLUSIONS

The results showed that the necessity to assess the affected area, staffing, and management actions, including integrated operations command and the development of a dedicated response plan, as well as the use of strategies inter-organizational coordination in the response phase to earthquake. This study also emphasized that providing standard equipment, support actions, and strengthening communication infrastructure, and updating the aerial emergency system should be considered as one of the priorities of the emergency organization of Iran to provide a desired response to the earthquake.

Standardised data collection in prehospital critical care: a comparison of medical problem categories and discharge diagnoses

Background

Prehospital medical problem reporting is essential in the management of helicopter emergency medical services (HEMS) operations. The consensus-based template for reporting and documenting in physician-staffed prehospital services exists and the classification of medical problems presented in the template is widely used in research and quality improvement. However, validation of the reported prehospital medical problem is lacking. This study aimed to describe the in-hospital diagnoses, patient characteristics and medical interventions in different categories of medical problems.

Methods

This retrospective, observational registry study examined the 10 most common in-hospital International Statistical Classification of Disease (ICD-10) diagnoseswithin different prehospital medical problem categories, defined by the HEMS physician/paramedic immediately after the mission was completed. Data were gathered from a national HEMS quality registry and a national hospital discharge registry. Patient characteristics and medical interventions related to different medical problem categories are also described.

Results

A total of 33,844 patients were included in the analyses. All the medical problem categories included a broad spectrum of ICD-10 diagnoses (the number of diagnosis classes per medical problem category ranged from 73 to 403). The most frequent diagnoses were mainly consistent with the reported medical problems. Overlapping of ICD-10 diagnoses was mostly seen in two medical problem categories: stroke and acute neurology excluding stroke. Additionally, typical patient characteristics and disturbances in vital signs were related to adequate medical problem categories.

Conclusions

Medical problems reported by HEMS personnel have adequate correspondence to hospital discharge diagnoses. However, the classification of cerebrovascular accidents remains challenging.

Characteristics of patients who received helicopter emergency medical services in Japan from 2012 to 2019: a retrospective analysis of data from Tochigi Prefecture

Background

Helicopter Emergency Medical Services (HEMS) has been in operation in Japan since 2001, allowing patients almost anywhere in the nation to receive on-scene emergency treatment from physicians. However, there is insufficient literature on the characteristics of the patients who use Japanese HEMS. Thus, this study aimed to investigate the overall characteristics of patients receiving HEMS care within a single prefecture in Japan.

Methods

We retrospectively analyzed the data of 5163 patients—in Tochigi Prefecture—who received HEMS care from 2012 to 2019. Descriptive statistics were used to analyze the following aspects of care: diagnosis, severity, background characteristics, geographical and environmental variables, immediate pre-hospital intervention, transportation type, and short-term clinical outcomes.

Results

Among 7370 HEMS requests received during the study period, treatment was provided to 5163 patients (1.8 cases per day; 3489 men [67.6%]). Nearly 55% (n = 2856) of patients were aged above 60 years. Age peaks were observed at 0–9 years and 60–69 years. The median distance from the base hospital to the site was 26.7 km. The age-standardized rate of HEMS treatment was 30.3 patients per 100,000 people. Cases of trauma and cardiovascular diseases were the most common (65.3%). Most individuals aged 0–9 years and 60–69 years had neurological disease (seizures accounted for 80.5% of this group) and cardiovascular disease, respectively. The number of patients was similar across all four seasons. After immediate pre-hospital intervention, 81.6% of patients receiving HEMS care were transferred by the helicopter ambulance (53.4% and 28.2% to the base hospital and to other hospitals, respectively). Overall, 56.6% of patients receiving HEMS care were transferred to the base hospital, and the short-term recovery rate was above 75%. Intravenous drip and oxygen administration were the most common pre-hospital interventions (93.1% and 72.7%, respectively).

Conclusions

This study is the first to describe the overall characteristics of HEMS patients using comprehensive data of all HEMS patients in one prefecture in Japan. Further research using both local- and national-level data is needed to accelerate the understanding of the benefits of HEMS.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13049-022-01012-6.

The Role of a Physician-Staffed Helicopter in Emergency Care of Patients on Isolated Danish Islands

Emergency calls may lead to the dispatch of either ground ambulances or helicopter emergency medical services (HEMS). For residents on isolated islands, the HEMS can reduce the time to hospital admission and lead to improved outcomes. This study investigated the emergency care for residents on isolated islands with a focus on the role of a physician-staffed helicopter. The data were obtained from Danish national registries and databases. We included data on emergency calls from isolated islands from the time of emergency call to discharge. We identified 1130 emergency calls from which 775 patients were registered with a hospital admission. Of these, 41% were transported by the HEMS and 36% by a ground ambulance. The median time to admission was 83 min (IQR 66-104) and 90 min (IQR 45-144) for the HEMS and ground ambulance, respectively (p = 0.26). The overall 30-day mortality was 6.2% (95% CI: 4.6-8.1%), and 37% of all the patients were admitted to the hospital with an unspecified diagnosis. The emergency calls from isolated islands led to the dispatch of the HEMS in 41% of the cases. The use of the HEMS did not significantly reduce the time to admission but was used in a greater proportion of patients with an acute cardiac disease (66%) or stroke (67%).

Transferred Patients by Fars Province's Helicopter Emergency Medical Service (HEMS); A 2-Years Cross-Sectional Study in Southern Iran

Objective:

To investigate the patients transferred by helicopters, as well as an emergent medical services that were performed for them.

Methods:

In this retrospective cross-sectional study, all patients who were transferred by Fars province of Helicopter Emergency Medical Services (HEMS) to Shiraz hospitals, southern Iran (March 2017-March 2019) were investigated. Patients’ information was collected and analyzed includes age, gender, dispatch reason, trauma mechanisms, take hold of emergent medical services, as well as the air transportation time, time between dispatch from the origin hospital and starting the procedures, and patients’ outcome.

Results:

Eighty-three patients were enrolled with the mean±SD age of 36.9±19.47 years that 75.9% had trauma (p<0.0001). Mental status deterioration (25.3%) was the most dispatched indications. The mortality rate was 13.25% totally (11.11% in traumatic vs. 10% in non-traumatic). The mean±SD of air transportation time was significantly lower than ground transportation in both traumatic (p=0.0013) and non-traumatic (p<0.0001) patients. Also, the mean±SD of time between dispatch from the origin hospital and starting the procedures was statistically lower in air transportation in both traumatic (p=0.0028) and non-traumatic (p=0.0017) patients.

Conclusion:

Most of the patients transferred by HEMS were traumatic. The air transportation time as well as the time between dispatches from the origin hospital to the starting of the procedures were significantly lower in HEMS in comparison with ground transportation for both traumatic and non-traumatic patients.

Dispatch of a helicopter emergency medicine service to patients with a sudden, unexplained loss of consciousness of medical origin

Background

Sudden loss of consciousness (LOC) in the prehospital setting in the absence of cardiac arrest and seizure activity may be a challenge from a dispatcher’s perspective: The aetiology is varied, with many causes being transient and mostly self-limiting, whereas other causes are potentially life threatening. In this study we aim to evaluate the dispatch of HEMS to patients with LOC of medical origin, by exploring to which patients with a LOC HEMS is dispatched, which interventions HEMS teams perform in these patients, and whether HEMS interventions can be predicted by patient characteristics.

Methods

We performed retrospective cohort study of all patients with a reported unexplained LOC (e.g. not attributable to a circulatory arrest or seizures) attended by the Air Ambulance Kent, Surrey & Sussex (AAKSS), over a 4-year period (July 2013–December 2017). Primary outcome was defined as the number of HEMS-specific interventions performed in patients with unexplained LOC. Secondary outcome was the relation of clinical- and dispatch criteria with HEMS interventions being performed.

Results

During the study period, 127 patients with unexplained LOC were attended by HEMS. HEMS was dispatched directly to 25.2% of the patients, but mostly (74.8%) on request of the ground ambulance crews. HEMS interventions were performed in 65% of the patients (Prehospital Emergency Anaesthesia 56%, hyperosmolar therapy 21%, antibiotic/antiviral therapy 8%, vasopressor therapy 6%) and HEMS conveyed most patients (77%) to hospital. Acute neurological pathology was a prevalent underlying cause of unexplained LOC: 38% had gross pathology on their CT-scan upon arrival in hospital. Both GCS (r = − 0.60, p < .001) and SBP (r = 0.31, p < .001) were related to HEMS interventions being performed on scene. A GCS < 13 predicted the need for HEMS interventions in our population with a sensitivity of 94.9% and a specificity 75% (AUC 0.85).

Conclusion

HEMS dispatchers and ambulance personnel are able to identify a cohort of patients with unexplained LOC of medical origin who suffer from potentially life threatening (mainly neurological) pathology, in whom HEMS specific intervention are frequently required. Presenting GCS can be used to inform the triage process of patients with LOC at an early stage.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12873-020-00388-x.

The first seven years of nationally organized helicopter emergency medical services in Finland - the data from quality registry

Background

Helicopter Emergency Medical Services (HEMS) play an important role in prehospital care of the critically ill. Differences in funding, crew composition, dispatch criteria and mission profile make comparison between systems challenging. Several systems incorporate databases for quality control, performance evaluation and scientific purposes. FinnHEMS database was incorporated for such purposes following the national organization of HEMS in Finland 2012. The aims of this study are to describe information recorded in the database, data collection, and operational characteristics of Finnish HEMS during 2012–2018.

Methods

All dispatches of the six Finnish HEMS units recorded in the national database from 2012 to 2018 were included in this observational registry study. Five of the units are physician staffed, and all are on call 24/7. The database follows a template for uniform reporting in physician staffed pre-hospital services, exceeding the recommended variables of relevant guidelines.

Results

The study included 100,482 dispatches, resulting in 33,844 (34%) patient contacts. Variables were recorded with little or no missing data. A total of 16,045 patients (16%) were escorted by HEMS to hospital, of which 2239 (2%) by helicopter. Of encountered patients 4195 (4%) were declared deceased on scene. The number of denied or cancelled dispatches was 66,638 (66%). The majority of patients were male (21,185, 63%), and the median age was 57.7 years. The median American Society of Anesthesiologists Physical Scale classification was 2 and Eastern Cooperative Oncology Group performance class 0. The most common reason for response was trauma representing 26% (8897) of the patients, followed by out-of-hospital cardiac arrest 20% (6900), acute neurological reason excluding stroke 13% (4366) and intoxication and related psychiatric conditions 10% (3318). Blunt trauma (86%, 7653) predominated in the trauma classification.

Conclusions

Gathering detailed and comprehensive data nationally on all HEMS missions is feasible. A national database provides valuable insights into where the operation of HEMS could be improved. We observed a high number of cancelled or denied missions and a low percentage of patients transported by helicopter. The medical problem of encountered patients also differs from comparable systems.

What clinical crew competencies and qualifications are required for helicopter emergency medical services? A review of the literature

BACKGROUND

Patients served by Helicopter Emergency Medical Services (HEMS) tend to be acutely injured or unwell and in need of stabilisation followed by rapid and safe transport. It is therefore hypothesised that a particular clinical crew composition is required to provide appropriate HEMS patient care. A literature review was performed to test this hypothesis.

METHODS

MEDLINE, EMBASE, Web of Science and the Cochrane Database of Systematic Reviews were systematically searched from 1 January 2009 to 30 August 2019 to identify peer-reviewed articles of relevance. All HEMS studies that mentioned 'staffing', 'configuration', 'competencies' or 'qualifications' in the title or abstract were selected for full-text review.

RESULTS

Four hundred one studies were identified. Thirty-eight studies, including one systematic review and one randomised controlled trial, were included. All remaining studies were of an observational design. The vast majority of studies described clinical crews that were primarily doctor-staffed. Descriptions of non-doctor staff competencies were limited, with the exception of one paramedic-staffed model.

CONCLUSIONS

HEMS clinical crews tended to have a wider range of competencies and experience than ground-based crews, and most studies suggested a patient outcome benefit to HEMS provision. The conclusions that can be drawn are limited due to study quality and the possibility that the literature reviewed was weighted towards particular crewing models (i.e. primarily doctor-staffed) and countries. There is a need for trial-based studies that directly compare patient outcomes between different HEMS crews with different competencies and qualifications.

Future development of helicopter emergency medical services in Korea

This paper discusses the future development of air ambulance operations in Korea. Helicopter emergency medical services are a useful means of transporting critically ill patients to the right hospital, at the right time. It is an important element of the emergency medical system to treat acute diseases at the scene, or in transit. For more efficient operations of the emergency medical helicopters (air ambulances or the so-called ‘Doctor Helgi’ in Korea), various challenges are faced. These include, the expansion of air ambulance bases, proper placement of rendezvous points (landing point), increase of field transport requests, and the operation of night missions. First, it is necessary to reduce the disparity in the benefits of emergency medical care for critically ill patients through the expansion of helicopter bases. Second, through the advancement of joint operations of the pan-ministerial emergency medical helicopters, the time from dispatch to helicopter take-off should be minimized, and a quality improvement program for air transportation should be carried out. Third, it is necessary to increase the number of insufficient rendezvous points and ensure the safety of the helicopters during takeoff and landing, to activate field transportation. Finally, the safety of patients and medical staff should be secured through the systematic preparation of the air transport system for future night missions. To solve these tasks, an appropriate legal system for helicopter emergency medical service is required. Based on the improved system, it is expected that everyone will enjoy equal rights for health, regardless of the regions.

The NACA score as a predictor of ventricular cardiac arrhythmias - A retrospective six-year study

BACKGROUND

Helicopter Emergency Medical Service (HEMS) conducts the evaluation of a patient's condition using NACA score before transporting the patient to hospital. The conditions inside the rescue helicopter limit or even make it impossible to conduct some medical procedures. An appropriate classification of the patient may lead to a lower possibility of occurrence of adverse events during the flight. The aim of the research was to evaluate the correlation of NACA score with the cardiac arrhythmia that may be life threatening.

METHODS

A retrospective observational study included a group of 47,131 patients, who were transported by HEMS services between 2012 and 2017. The research was conducted using the analysis of variance ANOVA running a post hoc test. In order to calculate the correlation of variables, Kruskal-Wallis and r-Pearson tests were carried out, interpreting the results according to J. Gilville's scale. The significance level was set at α = 0,05.

RESULTS

The average number of points using NACA score for the studied group was 4,06 (SD ± 1,38). Twelve heart rhythms were selected while evaluating correlations using NACA score. There was a significant relation between the ECG variable and NACA score (p = 0,003). There was a very strong correlation between NACA score and the following: VF/pVT (r-Pearson = 0,856; p = 0,006), PEA (r-Pearson = 0,810; p = 0,015) and Asystole (r-Pearson = 0,728; p = 0,026).

CONCLUSIONS

NACA score allows to predict the risk of occurrence of ventricular arrhythmia of the myocardium as well as cardiac arrest. The possibility of occurrence of a life-threatening rhythm is significantly higher in patients classified as NACA IV or higher.

Helicopter Emergency Medical Services in 2017 Kermanshah Earthquake; a Qualitative Study

INTRODUCTION

Becoming aware of experiences, and lessons learned in challenges can help optimize planning and improve efficiency and effectiveness. The present study aimed to address the challenges of helicopter emergency medical services (HEMS) from the viewpoint of the managers involved in HEMS in Kermanshah earthquake.

METHODS

This qualitative research was done using the content analysis method. The data were collected by semi-structured interviews.  The study population consisted of directors who participated in management and transfer of injured people in the earthquake-stricken area of Kermanshah. Sampling was purposeful in the first stage and then by the snowballed method.

RESULTS

In the present study, 479 codes were initially extracted regarding participants' perspectives and experiences and after eliminating duplicates, 53 codes were finalized. After analyzing the data, 4 categories and 12 sub-categories were extracted. In this research, lack of integrated management and process-oriented preparedness were the subjects with the highest number of codes.

CONCLUSION

According to the findings of this study, it is suggested that comprehensive training programs should be implemented for effective management of the air emergency process during disasters such as earthquakes.

Helicopter Emergency Medical Service (HEMS) Response in Rural Areas in Poland: Retrospective Study

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.

The Danish helicopter emergency medical service database: high quality data with great potential

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.