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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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Vianen NJ, Maissan IM, den Hartog D, Stolker RJ, Houmes RJ, Gommers DAMPJ, Van Meeteren NLU, Hoeks SE, Van Lieshout EMM, Verhofstad MHJ, Van Vledder MG. Opportunities and barriers for prehospital emergency medical services research in the Netherlands; results of a mixed-methods consensus study. Eur J Trauma Emerg Surg 2024; 50:221-232. [PMID: 36869883 PMCID: PMC10924026 DOI: 10.1007/s00068-023-02240-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 01/31/2023] [Indexed: 03/05/2023]
Abstract
INTRODUCTION Quality improvement in prehospital emergency medical services (EMS) can only be achieved by high-quality research and critical appraisal of current practices. This study examines current opportunities and barriers in EMS research in the Netherlands. METHODS This mixed-methods consensus study consisted of three phases. The first phase consisted of semi-structured interviews with relevant stakeholders. Thematic analysis of qualitative data derived from these interviews was used to identify main themes, which were subsequently discussed in several online focus groups in the second phase. Output from these discussions was used to shape statements for an online Delphi consensus study among relevant stakeholders in EMS research. Consensus was met if 80% of respondents agreed or disagreed on a particular statement. RESULTS Forty-nine stakeholders participated in the study; qualitative thematic analysis of the interviews and focus group discussions identified four main themes: (1) data registration and data sharing, (2) laws and regulations, (3) financial aspects and funding, and (4) organization and culture. Qualitative data from the first two phases of the study were used to construct 33 statements for an online Delphi study. Consensus was reached on 21 (64%) statements. Eleven (52%) of these statements pertained to the storage and use of EMS patient data. CONCLUSION Barriers for prehospital EMS research in the Netherlands include issues regarding the use of patient data, privacy and legislation, funding and research culture in EMS organizations. Opportunities to increase scientific productivity in EMS research include the development of a national strategy for EMS data and the incorporation of EMS topics in research agendas of national medical professional associations.
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Affiliation(s)
- Niek J Vianen
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. BOX 2040, 3000 CA, Rotterdam, The Netherlands
- Department of Anesthesiology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Iscander M Maissan
- Department of Anesthesiology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Dennis den Hartog
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. BOX 2040, 3000 CA, Rotterdam, The Netherlands
| | - Robert J Stolker
- Department of Anesthesiology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Robert J Houmes
- Department of Anesthesiology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | | | - Nico L U Van Meeteren
- Department of Anesthesiology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Sanne E Hoeks
- Department of Anesthesiology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Esther M M Van Lieshout
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. BOX 2040, 3000 CA, Rotterdam, The Netherlands
| | - Michael H J Verhofstad
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. BOX 2040, 3000 CA, Rotterdam, The Netherlands
| | - Mark G Van Vledder
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. BOX 2040, 3000 CA, Rotterdam, The Netherlands.
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Wolthers SA, Breindahl N, Jensen TW, Holgersen MG, Møller TP, Blomberg SNF, Andersen LB, Mikkelsen S, Steinmetz J, Christensen HC. Prehospital interventions and outcomes in traumatic cardiac arrest: a population-based cohort study using the Danish Helicopter Emergency Medical Services data. Eur J Emerg Med 2023:00063110-990000000-00106. [PMID: 38100645 DOI: 10.1097/mej.0000000000001108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Abstract
BACKGROUND AND IMPORTANCE Traumatic cardiac arrest is associated with poor prognosis, and timely evidence-based treatment is paramount for increasing survival rates. Physician-staffed helicopter emergency medical service use in major trauma has demonstrated improved outcomes. However, the sparsity of data highlights the necessity for a comprehensive understanding of the epidemiology of traumatic cardiac arrest. OBJECTIVES The primary objective of the present study was to evaluate survival and return of spontaneous circulation (ROSC) and to investigate the characteristics of patients with traumatic cardiac arrest assessed by the Danish HEMS. DESIGN This was a population-based cohort study based on data from the Danish helicopter emergency medical service database. SETTINGS AND PARTICIPANTS The study included all patients assessed by the Danish helicopter emergency medical services between 2016 and 2021. OUTCOME MEASURES AND ANALYSIS Data were analysed using descriptive statistics, non-parametric testing and logistic regression analyses. Descriptive analysis of prehospital interventions included cardiopulmonary resuscitation, defibrillation, airway management, administration of blood products, and thoracic decompression. The primary outcome was 30-day survival, and the key secondary outcome was prehospital ROSC. MAIN RESULTS A total of 223 patients with TCA were included. The median age was 54 years (IQR 34-68), and the majority were males. Overall, 23% of patients achieved prehospital ROSC, and the 30-day survival rate was 4%. Factors associated with an increased likelihood of ROSC were an initial shockable cardiac rhythm, odds ratio (OR) of 3.78 (95% CI 1.33-11.00) and endotracheal intubation, OR 7.10 (95% CI 2.55-22.85). CONCLUSION This study highlights the low survival rates observed among patients with traumatic cardiac arrest assessed by helicopter emergency medical services. The findings support the positive impact of an initial shockable cardiac rhythm and endotracheal intubation in improving the likelihood of ROSC. The study contributes to the limited literature on traumatic cardiac arrests assessed by physician-staffed helicopter emergency services. Finally, the findings emphasise the need for further research to understand and improve outcomes in this subgroup of cardiac arrest.
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Affiliation(s)
- Signe Amalie Wolthers
- Prehospital Center, Region Zealand, Næstved
- Department of Clinical Medicine, University of Copenhagen
| | - Niklas Breindahl
- Prehospital Center, Region Zealand, Næstved
- Department of Clinical Medicine, University of Copenhagen
- Department of Neonatal and Paediatric Intensive Care, Copenhagen University Hospital, Rigshospitalet, Copenhagen
| | - Theo Walther Jensen
- Prehospital Center, Region Zealand, Næstved
- Department of Anaesthesiology and Intensive care Medicine, Copenhagen University Hospital, Herlev
| | - Mathias Geldermann Holgersen
- Department of Clinical Medicine, University of Copenhagen
- Paediatric Pulmonary Service, Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen
| | - Thea Palsgaard Møller
- Prehospital Center, Region Zealand, Næstved
- Department of Anesthesiology and Intensive Care Medicine, Holbæk hospital, Region Zealand
| | | | | | - Søren Mikkelsen
- Prehospital Research Unit, Department of Anaesthesiology and Intensive Care, Odense University Hospital, Odense
| | - Jacob Steinmetz
- Department of Anaesthesia and Trauma Centre, Centre of Head and Orthopaedics, Copenhagen University Hospital, Rigshospitalet, Copenhagen
- Danish Air Ambulance
- Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Helle Collatz Christensen
- Prehospital Center, Region Zealand, Næstved
- Department of Clinical Medicine, University of Copenhagen
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McDonald N, Little N, Kriellaars D, Doupe MB, Giesbrecht G, Pryce RT. Database quality assessment in research in paramedicine: a scoping review. Scand J Trauma Resusc Emerg Med 2023; 31:78. [PMID: 37951904 PMCID: PMC10638787 DOI: 10.1186/s13049-023-01145-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 11/05/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND Research in paramedicine faces challenges in developing research capacity, including access to high-quality data. A variety of unique factors in the paramedic work environment influence data quality. In other fields of healthcare, data quality assessment (DQA) frameworks provide common methods of quality assessment as well as standards of transparent reporting. No similar DQA frameworks exist for paramedicine, and practices related to DQA are sporadically reported. This scoping review aims to describe the range, extent, and nature of DQA practices within research in paramedicine. METHODS This review followed a registered and published protocol. In consultation with a professional librarian, a search strategy was developed and applied to MEDLINE (National Library of Medicine), EMBASE (Elsevier), Scopus (Elsevier), and CINAHL (EBSCO) to identify studies published from 2011 through 2021 that assess paramedic data quality as a stated goal. Studies that reported quantitative results of DQA using data that relate primarily to the paramedic practice environment were included. Protocols, commentaries, and similar study types were excluded. Title/abstract screening was conducted by two reviewers; full-text screening was conducted by two, with a third participating to resolve disagreements. Data were extracted using a piloted data-charting form. RESULTS Searching yielded 10,105 unique articles. After title and abstract screening, 199 remained for full-text review; 97 were included in the analysis. Included studies varied widely in many characteristics. Majorities were conducted in the United States (51%), assessed data containing between 100 and 9,999 records (61%), or assessed one of three topic areas: data, trauma, or out-of-hospital cardiac arrest (61%). All data-quality domains assessed could be grouped under 5 summary domains: completeness, linkage, accuracy, reliability, and representativeness. CONCLUSIONS There are few common standards in terms of variables, domains, methods, or quality thresholds for DQA in paramedic research. Terminology used to describe quality domains varied among included studies and frequently overlapped. The included studies showed no evidence of assessing some domains and emerging topics seen in other areas of healthcare. Research in paramedicine would benefit from a standardized framework for DQA that allows for local variation while establishing common methods, terminology, and reporting standards.
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Affiliation(s)
- Neil McDonald
- Winnipeg Fire Paramedic Service, EMS Training, 2546 McPhillips St, Winnipeg, MB, R2P 2T2, Canada.
- Department of Emergency Medicine, Max Rady College of Medicine, University of Manitoba, S203 Medical Services Building, 750 Bannatyne Ave, Winnipeg, MB, R3E 0W2, Canada.
- Applied Health Sciences, University of Manitoba, 202 Active Living Centre, Winnipeg, MB, R3T 2N2, Canada.
| | - Nicola Little
- Winnipeg Fire Paramedic Service, EMS Training, 2546 McPhillips St, Winnipeg, MB, R2P 2T2, Canada
| | - Dean Kriellaars
- College of Rehabilitation Sciences, Rady Faculty of Health Sciences, University of Manitoba, 771 McDermot Ave, Winnipeg, MB, R3E 0T6, Canada
| | - Malcolm B Doupe
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, 750 Bannatyne Ave, Winnipeg, MB, R3E 0W2, Canada
| | - Gordon Giesbrecht
- Faculty of Kinesiology and Recreation Management, University of Manitoba, 102-420 University Crescent, Winnipeg, MB, R3T 2N2, Canada
| | - Rob T Pryce
- Department of Kinesiology and Applied Health, Gupta Faculty of Kinesiology, University of Winnipeg, 400 Spence St, Winnipeg, MB, R3B 2E9, Canada
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Greene A, Dion PM, Nolan B, Trachter R, Vu E, Trojanowski J. Overcoming distance: an exploration of current practices of government and charity-funded critical care transport and retrieval organizations. Scand J Trauma Resusc Emerg Med 2023; 31:52. [PMID: 37789319 PMCID: PMC10548638 DOI: 10.1186/s13049-023-01125-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 09/26/2023] [Indexed: 10/05/2023] Open
Abstract
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.
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Affiliation(s)
- Adam Greene
- British Columbia Emergency Health Services, Provincial Health Services Authority, Victoria, BC, Canada.
- School of Medicine, Cardiff University, Cardiff, Wales, UK.
| | - Pierre-Marc Dion
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Brodie Nolan
- Department of Emergency Medicine, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Rob Trachter
- Department of Emergency Medicine, Nanaimo Regional General Hospital, Nanaimo, BC, Canada
| | - Erik Vu
- British Columbia Emergency Health Services, Provincial Health Services Authority, Victoria, BC, Canada
- Division of Emergency Medicine, Department of Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
- Division of Critical Care Medicine, Department of Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Jan Trojanowski
- British Columbia Emergency Health Services, Provincial Health Services Authority, Victoria, BC, Canada
- Division of Critical Care Medicine, Department of Medicine, Kelowna General Hospital, University of British Columbia, Kelowna, BC, Canada
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Vlok N, Wylie C, Stassen W. A 12-month retrospective descriptive analysis of a single helicopter emergency medical service operator in four South African provinces. Afr J Emerg Med 2023; 13:127-134. [PMID: 37275460 PMCID: PMC10238258 DOI: 10.1016/j.afjem.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 05/12/2023] [Accepted: 05/14/2023] [Indexed: 06/07/2023] Open
Abstract
Introduction Helicopter Emergency Medical Services (HEMS) is integrated into modern emergency medical services because of its suggested mortality benefit in certain patient populations, it is an expensive resource and appropriate use/feasibility in low- to middle income countries (LMIC) is highly debated. To maximise benefit, correct patient selection in HEMS is paramount. To achieve this, current practices first need to be described. The study aims to describe a population of patients utilising HEMS in South Africa, in terms of flight data, patient demographics, provisional diagnosis, as well as clinical characteristics and interventions. Methods A retrospective flight- and patient-chart review were conducted, extracting clinical and mission data of a single aeromedical operator in South Africa, over a 12-month period (July 2017 - June 2018) in Gauteng, Free State, Mpumalanga and North-West provinces. Results A total of 916 cases were included (203 primary cases, 713 interfacility transport (IFT) cases). Most patients transported were male (n=548, 59.8%) and suffered blunt trauma (n=379, 41.4%). Medical pathology (n=247, 27%) and neonatal transfers (n=184, 20.1%) follows. Flights occurred mainly in daylight hours (n=729, 79.6%) with median mission times of 1-hour 53 minutes (primary missions), and 3 hours 10 minutes (IFT missions). Median on-scene times were 26 minutes (primary missions) and 55 minutes (IFT missions). Almost half were transported with an endotracheal tube (n=428, 46.7%), with a large number receiving no respiratory support (n=414, 45.2%). No patients received fibrinolysis, defibrillation, cardioversion or cardiac pacing. Intravenous fluid therapy (n=867, 94.7%) was almost universal, with common administration of sedation (n=430, 46.9%) and analgesia (n=329, 35.9%). Conclusion Apart from the lack of universal call-out criteria and response to the high burden of trauma, HEMS seem to fulfil an important critical care transport role. It seems that cardiac pathologies are under-represented in this study and might have an important implication for crew training requirements.
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Oelrich R, Kjoelbye JS, Rosenkrantz O, Barfod C. Rendezvous between ambulances and prehospital physicians in the Capital Region of Denmark: a descriptive study. Scand J Trauma Resusc Emerg Med 2022; 30:52. [PMID: 36221109 PMCID: PMC9552492 DOI: 10.1186/s13049-022-01040-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 09/23/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In a two-tier Emergency Medical Services response system with ambulances and physician-staffed rapid response vehicles, both units are ideally dispatched simultaneously when a physician is needed. However, when advanced resources are dispatched secondarily, a meeting point (rendezvous) is established to reduce time to advanced care. This study aims to assess the extent of rendezvous tasks, patient groups involved and physician contribution when rendezvous is activated between the primary ambulances and rapid response vehicles in the Capital Region of Denmark. METHODS We analysed prehospital electronic patient record data from all rendezvous cases in the Capital Region of Denmark in 2018. Variables included the number of times rendezvous was activated, patient demographics, dispatch criteria, on-scene diagnosis, and prehospital treatment. RESULT Ambulances requested rendezvous 2340 times, corresponding to 1.3% of all ambulance tasks and 10.7% of all rapid response vehicle dispatches. The most frequently used dispatch criterion was unclear problem n = 561 (28.8%), followed by cardiovascular n = 439 (22.5%) and neurological n = 392 (20.1%). The physician contributed with technical skills like medication n = 760 (39.0%) and advanced airway management n = 161 (8.3%), as well as non-technical skills like team leading during advanced life support n = 152 (7.8%) and decision to end futile treatment and death certificate issuance n = 73 (3.7%). CONCLUSION Rendezvous between ambulances and physician-staffed rapid response vehicles was activated in 1.3% of all ambulance cases corresponding to 10.7% of all RRV dispatches in 2018. The three largest patient groups in rendezvous presented cardiovascular, neurological, and respiratory problems. The prehospital physician contributed with technical skills like medication and advanced airway management as well as non-technical skills like team leading during advanced life support and ending futile treatment. The high percentage of dispatch criterion unclear problem illustrates the challenge of precise dispatch and optimal use of prehospital resources. Therefore, it seems necessary to have a safe and rapid rendezvous procedure to cope with this uncertainty.
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Affiliation(s)
- Roselil Oelrich
- Copenhagen Emergency Medical Services, University of Copenhagen, Telegrafvej 5, 2750, Copenhagen, Capital Region of Denmark, Denmark.
| | - Julie Samsoee Kjoelbye
- Copenhagen Emergency Medical Services, University of Copenhagen, Telegrafvej 5, 2750, Copenhagen, Capital Region of Denmark, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Oscar Rosenkrantz
- Copenhagen Emergency Medical Services, University of Copenhagen, Telegrafvej 5, 2750, Copenhagen, Capital Region of Denmark, Denmark
| | - Charlotte Barfod
- Copenhagen Emergency Medical Services, University of Copenhagen, Telegrafvej 5, 2750, Copenhagen, Capital Region of Denmark, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Behrndtz A, Beare R, Iievlieva S, Andersen G, Mainz J, Gude M, Ma H, Srikanth V, Simonsen CZ, Phan T. Can Helicopters Solve the Transport Dilemma for Patients With Symptoms of Large-Vessel Occlusion Stroke in Intermediate Density Areas? A Simulation Model Based on Real Life Data. Front Neurol 2022; 13:861259. [PMID: 35547365 PMCID: PMC9082641 DOI: 10.3389/fneur.2022.861259] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 03/21/2022] [Indexed: 11/26/2022] Open
Abstract
Background This modeling study aimed to determine if helicopters may optimize the transportation of patients with symptoms of large vessel stroke in “intermediate density” areas, such as Denmark, by bringing them directly to the comprehensive stroke center. Methods We estimated the time for the treatment of patients requiring endovascular therapy or intravenous thrombolysis under four configurations: “drip and ship” with and without helicopter and “bypass” with and without helicopter. Time delays, stroke numbers per municipality, and helicopter dispatches for four helicopter bases from 2019 were obtained from the Danish Stroke and Helicopter Registries. Discrete event simulation (DES) was used to estimate the capacity of the helicopter fleet to meet patient transport requests, given the number of stroke codes per municipality. Results The median onset-to-needle time at the comprehensive stroke center (CSC) for the bypass model with the helicopter was 115 min [interquartile range (IQR): 108, 124]; the median onset-to-groin time was 157 min (IQR: 150, 166). The median onset-to-needle time at the primary stroke center (PSC) by ground transport was 112 min (IQR: 101, 125) and the median onset-to-groin time when primary transport to the PSC was prioritized was 234 min (IQR: 209, 261). A linear correlation between travel time by ground and the number of patients transported by helicopter (rho = 0.69, p < 0.001) indicated that helicopters are being used to transport more remote patients. DES demonstrated that an increase in helicopter capture zone by 20 min increased the number of rejected patients by only 5%. Conclusions Our model calculations suggest that using helicopters to transport patients with stroke directly to the CSC in intermediate density areas markedly reduce onset-to-groin time without affecting time to thrombolysis. In this setting, helicopter capacity is not challenged by increasing the capture zone.
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Affiliation(s)
- Anne Behrndtz
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Richard Beare
- Department of Medicine, School of Clinical Sciences at Monash Health, Stroke and Ageing Research, Monash University, Melbourne, VIC, Australia
| | - Svitlana Iievlieva
- Department of Medicine, School of Clinical Sciences at Monash Health, Stroke and Ageing Research, Monash University, Melbourne, VIC, Australia
| | - Grethe Andersen
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Jeppe Mainz
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Martin Gude
- Department of Clinical Medicine, Prehospital Department, Aarhus, Denmark
| | - Henry Ma
- Department of Medicine, School of Clinical Sciences at Monash Health, Stroke and Ageing Research, Monash University, Melbourne, VIC, Australia
| | - Velandai Srikanth
- Department of Medicine, School of Clinical Sciences at Monash Health, Stroke and Ageing Research, Monash University, Melbourne, VIC, Australia
| | - Claus Z Simonsen
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Than Phan
- Department of Medicine, School of Clinical Sciences at Monash Health, Stroke and Ageing Research, Monash University, Melbourne, VIC, Australia
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Nielsen VM, Bruun NH, Søvsø MB, Kløjgård TA, Lossius HM, Bender L, Mikkelsen S, Tarpgaard M, Petersen JA, Christensen EF. Pediatric Emergencies in Helicopter Emergency Medical Services: A National Population-Based Cohort Study From Denmark. Ann Emerg Med 2022; 80:143-153. [DOI: 10.1016/j.annemergmed.2022.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 03/25/2022] [Accepted: 03/28/2022] [Indexed: 11/28/2022]
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Tommila M, Pappinen J, Raatiniemi L, Saviluoto A, Toivonen T, Björkman J, Nurmi J. Standardised data collection in prehospital critical care: a comparison of medical problem categories and discharge diagnoses. Scand J Trauma Resusc Emerg Med 2022; 30:26. [PMID: 35413859 PMCID: PMC9006464 DOI: 10.1186/s13049-022-01013-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 03/31/2022] [Indexed: 11/23/2022] Open
Abstract
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.
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Affiliation(s)
- Miretta Tommila
- Department of Perioperative Services, Intensive Care Medicine and Pain Management, Turku University Hospital and University of Turku, Turku, Finland
| | | | - Lasse Raatiniemi
- Centre for Prehospital Emergency Care, Oulu, Finland.,Research Group of Surgery, Anaesthesiology and Intensive Care, Division of Anesthesiology Oulu University Hospital, Medical Research Centre, University of Oulu, Oulu, Finland
| | - Anssi Saviluoto
- FinnHEMS Ltd, HEMS Operations, Vantaa, Finland.,University of Eastern Finland, Kuopio, Finland
| | | | - Johannes Björkman
- FinnHEMS Ltd, HEMS Operations, Vantaa, Finland.,Emergency Medicine and Services, Helsinki University Hospital and University of Helsinki, FinnHEMS 10, Vesikuja 9, 01530, Vantaa, Finland
| | - Jouni Nurmi
- FinnHEMS Ltd, HEMS Operations, Vantaa, Finland. .,Emergency Medicine and Services, Helsinki University Hospital and University of Helsinki, FinnHEMS 10, Vesikuja 9, 01530, Vantaa, Finland.
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11
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Adam SB, Alstrup K, Rognås L. Secondary Transfers to University Hospitals in Patients Primarily Triaged to District General Hospitals by the Danish Helicopter Emergency Medical Service: A National Population-Based Study. Air Med J 2022; 41:57-62. [PMID: 35248344 DOI: 10.1016/j.amj.2021.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 08/20/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to analyze data from the Danish helicopter emergency medical service (HEMS) database, focusing on patients undergoing a secondary transfer from district general hospitals (DGHs) to university hospitals within 24 hours of the initial emergency call. METHODS This is a national population-based study analyzing HEMS patients undergoing a secondary transfer between October 1, 2014, and April 30, 2018. RESULTS Fifty-three (2.9%) of the 1,846 patients initially triaged to a DGH by the HEMS team required a secondary transfer. These 53 patients constituted 0.7% of all 7,133 patients seen by the HEMS teams during the study period. More than 60% of these patients were initially treated for either a cardiovascular or a neurologic emergency. HEMS-escorted patients had a mortality rate at day 30 of 14.3% (95% confidence interval, 4.8-38.0), and the HEMS-assisted group had a mortality rate at day 30 of 3.1% (95% CI, 0.5-20.2). CONCLUSION Patients initially triaged to a DGH by the HEMS teams seldomly required a secondary transfer, indicating a low degree of prehospital undertriage for direct transfer to a university hospital. Cardiovascular or neurologic emergencies were the major reasons for transportation. Mortality seems comparable with that in the general population of patients treated by the Danish HEMS teams.
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Affiliation(s)
- Sidsel Bjørgo Adam
- Department of Research and Development, Pre-hospital Emergency Medical Services, Central Denmark Region, Aarhus, Denmark
| | - Karen Alstrup
- Department of Research and Development, Pre-hospital Emergency Medical Services, Central Denmark Region, Aarhus, Denmark.
| | - Leif Rognås
- Department of Research and Development, Pre-hospital Emergency Medical Services, Central Denmark Region, Aarhus, Denmark; Department of Anaesthesiology, Aarhus University Hospital, Aarhus, Denmark; The Danish Air Ambulance, Aarhus, Denmark
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12
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The Role of a Physician-Staffed Helicopter in Emergency Care of Patients on Isolated Danish Islands. Healthcare (Basel) 2021; 9:healthcare9111446. [PMID: 34828492 PMCID: PMC8625314 DOI: 10.3390/healthcare9111446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/13/2021] [Accepted: 10/22/2021] [Indexed: 11/17/2022] Open
Abstract
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%).
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13
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Møller TP, Ersbøll AK, Kjærulff TM, Bihrmann K, Alstrup K, Knudsen L, Hansen TM, Berlac PA, Lippert F, Barfod C. Helicopter emergency medical services missions to islands and the mainland during a 3-year period in Denmark: a population-based study on patient and sociodemographic characteristics, comorbidity, and use of healthcare services. Scand J Trauma Resusc Emerg Med 2021; 29:152. [PMID: 34663396 PMCID: PMC8522108 DOI: 10.1186/s13049-021-00963-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 09/30/2021] [Indexed: 11/12/2022] Open
Abstract
Background The Danish Helicopter Emergency Medical Services (HEMS) is part of the Danish Emergency Medical Services System serving 5.7 million citizens with 1% living on islands not connected to the mainland by road. HEMS is dispatched based on pre-defined criteria including severity and urgency, and moreover to islands for less urgent cases, when rapid transport to further care is needed. The study aim was to characterize patient and sociodemographic factors, comorbidity and use of healthcare services for patients with HEMS missions to islands versus mainland. Methods Descriptive study of data from the HEMS database in a three-year period from 1 October 2014 to 30 September 2017. All missions in which a patient was either treated on scene or transported by HEMS were included. Results Of 5776 included HEMS missions, 1023 (17.7%) were island missions. In total, 90.2% of island missions resulted in patient transport by HEMS compared with 62.1% of missions to the mainland. Disease severity was serious or life-threatening in 34.7% of missions to islands compared with 65.1% of missions to mainland and less interventions were performed by HEMS on island missions. The disease pattern differed with more “Other diseases” registered on islands compared with the mainland where cardiovascular diseases and trauma were the leading causes of contact. Patients from islands were older than patients from the mainland. Sociodemographic characteristics varied between inhabiting island patients and mainland patients: more island patients lived alone, less were employed, more were retired, and more had low income. In addition, residing island patients had to a higher extend severe comorbidity and more contacts to general practitioners and hospitals compared with the mainland patients. Conclusions HEMS missions to islands count for 17.7% of HEMS missions and 90.2% of island missions result in patient transport. The island patients encountered by HEMS are less severely diseased or injured and interventions are less frequently performed. Residing island patients are older than mainland patients and have lower socioeconomic position, more comorbidities and a higher use of health care services. Whether these socio-economic differences result in longer hospital stay or higher mortality is still to be investigated. Supplementary Information The online version contains supplementary material available at 10.1186/s13049-021-00963-6.
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Affiliation(s)
- Thea Palsgaard Møller
- Copenhagen Emergency Medical Services and University of Copenhagen, Copenhagen, Denmark.
| | - Annette Kjær Ersbøll
- National Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | | | - Kristine Bihrmann
- National Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Karen Alstrup
- Department of Research and Development, Pre-Hospital Emergency Medical Services, Central Denmark Region, Aarhus, Denmark
| | - Lars Knudsen
- Department of Anesthesiology, Aarhus University Hospital, Aarhus, Denmark.,The Danish Air Ambulance, Aarhus, Denmark
| | | | - Peter Anthony Berlac
- Copenhagen Emergency Medical Services and University of Copenhagen, Copenhagen, Denmark
| | - Freddy Lippert
- Copenhagen Emergency Medical Services and University of Copenhagen, Copenhagen, Denmark
| | - Charlotte Barfod
- Copenhagen Emergency Medical Services and University of Copenhagen, Copenhagen, Denmark
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14
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Sørensen LM, Rognås L, Alstrup K. Trauma Versus Nontrauma Patients Treated by the Danish Helicopter Emergency Medical Service: A Register-Based Study of Patient Characteristics, Hospitalization, and Mortality. Air Med J 2021; 40:325-330. [PMID: 34535240 DOI: 10.1016/j.amj.2021.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/31/2021] [Accepted: 05/12/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Helicopter emergency medical services (HEMS) are part of many emergency health care systems, ensuring specialized treatment on scene. An accurate use is important for improved resource utilization. The aim of this study was to describe patient characteristics, hospitalization, and mortality in trauma and nontrauma patients seen by the Danish HEMS teams. METHODS The study is a registry-based study presenting data from the national Danish HEMS database. We included all HEMS missions from October 1, 2014, to April 30, 2018. RESULTS A total of 13,391 HEMS entries were registered, and 5,524 cases were included in the study. Trauma patients were younger (38 vs. 63 years) and had a lower level of comorbidities (Charlson Comorbidity Index 0: 82% vs. 58%) compared with nontrauma patients. More nontrauma cases were classified with a severity score corresponding to a critical emergency. They also had a higher 30-day mortality compared with trauma patients (26% vs. 11%). CONCLUSION This national study demonstrated differences in demographics, the severity profile, and mortality among trauma compared with nontrauma patients that could possibly indicate an overuse of HEMS for minor trauma cases. The results might suggest that educational efforts and a review of the current dispatch guidelines could be of importance when trying to improve the use of HEMS.
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Affiliation(s)
- Louise Marqvard Sørensen
- Department of Research and Development, Pre-hospital Emergency Medical Services, Central Denmark Region, Aarhus, Denmark
| | - Leif Rognås
- Department of Research and Development, Pre-hospital Emergency Medical Services, Central Denmark Region, Aarhus, Denmark; Department of Anaesthesiology, Aarhus University Hospital, Aarhus, Denmark; The Danish Air Ambulance, Aarhus, Denmark
| | - Karen Alstrup
- Department of Research and Development, Pre-hospital Emergency Medical Services, Central Denmark Region, Aarhus, Denmark.
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15
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Saviluoto A, Jäntti H, Holm A, Nurmi JO. Does experience in prehospital post-resuscitation critical care affect outcomes? A retrospective cohort study. Resuscitation 2021; 163:155-161. [PMID: 33811958 DOI: 10.1016/j.resuscitation.2021.03.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 02/20/2021] [Accepted: 03/21/2021] [Indexed: 12/12/2022]
Abstract
AIMS OF THE STUDY Helicopter Emergency Medical Services (HEMS) often provide post-resuscitation care. Our aims were to investigate whether physicians' frequent exposure to prehospital post-resuscitation care is associated with differences in (1) medical management, (2) achieving treatment targets recommended by resuscitation guidelines, (3) survival. METHODS We conducted a retrospective cohort study using data from a national HEMS quality register. We included patients between January 1st, 2012 and September 9th, 2019 who received post-resuscitation care by a HEMS physician. We excluded patients <16 years old. For each patient we determined the number of post-resuscitation cases the physician had attended in the previous 12 months. Patients were divided in to three groups: low (0-5), intermediate (6-11) and high exposure (≥12 cases). Medical management and proportions within treatment targets were compared. Survival at 30-days and 1-year was analysed by multivariate logistic regression analysis, controlling for known prognostic factors. RESULTS 2272 patients were analysed. Patients in the high exposure group had mechanical ventilation and vasoactive medications initiated more often (P < 0.001 and P = 0.008, respectively) and on-scene times were longer (P < 0.001). The target for blood pressure was achieved more often in this group (P = 0.026), but targets for oxygenation and ventilation were not. We did not see an association between survival and physicians' exposure to post-resuscitation care (odds ratio 0.96, 95% confidence interval 0.70-1.33 for low and 0.78, 0.56-1.08 for intermediate, compared to high exposure). CONCLUSIONS Physicians with more, frequent exposure take a more active approach to post-resuscitation care, but this does not seem to improve survival.
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Affiliation(s)
- Anssi Saviluoto
- Research and Development Unit, FinnHEMS, WTC Helsinki Airport, Lentäjäntie 3, FI-01530 Vantaa, Finland; University of Eastern Finland, Kuopio, Finland
| | - Helena Jäntti
- Kuopio University Hospital, Center for Prehospital Emergency Care, P.O. Box 100, FI-70029 Kuopio, Finland
| | - Aki Holm
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Jouni O Nurmi
- Research and Development Unit, FinnHEMS, WTC Helsinki Airport, Lentäjäntie 3, FI-01530 Vantaa, Finland; Emergency Medicine and Services, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
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16
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Developing Quality Indicators for Helicopter Emergency Medical Services Coordination in Norwegian Emergency Medical Communication Centrals: A Consensus Process. Air Med J 2021; 40:20-27. [PMID: 33455621 DOI: 10.1016/j.amj.2020.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 10/20/2020] [Accepted: 11/18/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Efforts to optimize the use, availability, and safety of helicopter emergency medical services (HEMS) is important. A lack of consistent and comprehensive flight dispatch procedures and a lack of use of safety technology are recurring safety problems. Reports after several major incidents pointed toward a possible gain by coordinating Norwegian HEMS from regional emergency medical communication centrals. Our objective was to develop and implement relevant quality indicators before such implementation in central Norway. METHODS We recruited an expert panel of 24 persons representing Norwegian health authorities, emergency medical communication centrals, and HEMS bases and performed a 3-step e-mail-based Delphi process to develop relevant quality indicators. Each indicator was assessed according to their feasibility, rankability, actionability, and variability. To reach a consensus, a median score of 5 or more on a 6-point Likert scale in step 3 was needed. RESULTS A total of 61 quality indicators were proposed. Of the 14 indicators that reached a consensus, 12 of these were considered process indicators, and 2 were bordering to outcome indicators. CONCLUSION We applied a Delphi process method to develop quality indicators for HEMS coordination and flight following. An experienced and heterogeneous expert panel suggested and reached a consensus on which quality indicators should be applied.
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17
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Alstrup K, Rognås L, Sollid S, Johnsen SP, Valentin JB, Petersen JAK. Association of Helicopter vs Ground Emergency Medical Transportation With 1-Year Mortality in Denmark. JAMA Netw Open 2021; 4:e2033318. [PMID: 33427886 PMCID: PMC7801934 DOI: 10.1001/jamanetworkopen.2020.33318] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
IMPORTANCE Appropriate use of helicopter emergency medical service (HEMS) is important in ensuring that patients with critical illness or injury receive adequate treatment. OBJECTIVE To investigate the association between use of HEMS compared with use of ground EMS (GEMS) and mortality overall and in a subgroup of patients with critical illness or injury. DESIGN, SETTING, AND PARTICIPANTS This register-based, nationwide cohort study used data retrieved from Danish registries from October 1, 2014, to April 30, 2018. Patients receiving GEMS originated from dispatched HEMS missions for which a helicopter was unavailable. For the primary analysis, patients from accepted HEMS missions and patients from missions in which HEMS was dispatched but unavailable were included. The secondary analysis included patients assigned a hospital International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) diagnosis considered a critical illness or injury. These patients were selected via a consensus-based agreement among all authors by reviewing the Danish version of the World Health Organization's ICD-10 classification. Data were analyzed from March to June 2020. EXPOSURES Dispatch of HEMS vs GEMS unit (primary analysis) and treatment and transport by HEMS vs GEMS unit among patients with critical illness or injury (secondary analysis). MAIN OUTCOMES AND MEASURES One-year mortality was retrieved from the Danish Civil Registration System. RESULTS Among 10 618 patients (median [interquartile range] age, 60 [42-72] years; 6834 [64.4%] men) included in the primary analysis, 9480 patients (89.3%) received HEMS and 1138 patients (10.7%) received GEMS. Median (interquartile range) age was 60 (42-72) years, and 6834 patients (64.4%) were men. Adjusted cumulative 1-year mortality was 23.2% (95% CI, 22.4%-24.1%) among patients receiving HEMS vs 24.5% (95% CI, 21.9%-27.1%) among patients receiving GEMS. The difference in mortality risk for HEMS compared with GEMS was not statistically significant (hazard ratio, 0.94 [95% CI, 0.84-1.06]). Among 2260 patients with critical illness or injury receiving HEMS, compared with 315 patients with critical illness or injury receiving GEMS, adjusted cumulative 1-year mortality was 25.1% (95% CI, 23.5%-26.7%) vs 27.1% (95% CI, 22.0%-32.1%). The difference in mortality risk for HEMs compared with GEMs was not statistically significant (hazard ratio, 0.91 [95% CI, 0.73-1.14]). CONCLUSIONS AND RELEVANCE This study found that 1 year after dispatch, the use of HEMS, compared with the use of GEMS, was not associated with a statistically significant difference in mortality overall or mortality among patients with critical illness or injury. Further research is needed to determine whether optimized dispatch systems may be associated with further improvements in survival among selected patients.
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Affiliation(s)
- Karen Alstrup
- Department of Research and Development, Prehospital Emergency Medical Services, Central Denmark Region, Aarhus, Denmark
| | - Leif Rognås
- Department of Research and Development, Prehospital Emergency Medical Services, Central Denmark Region, Aarhus, Denmark
- Department of Anaesthesiology, Aarhus University Hospital, Aarhus, Denmark
- Danish Air Ambulance, Denmark
| | - Stephen Sollid
- Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
- Norwegian Air Ambulance Foundation, Oslo, Norway
| | - Søren Paaske Johnsen
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University and Aalborg University Hospital, Aalborg, Denmark
| | - Jan Brink Valentin
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University and Aalborg University Hospital, Aalborg, Denmark
| | - Jens Aage Kølsen Petersen
- Department of Anaesthesiology, Aarhus University Hospital, Aarhus, Denmark
- Danish Air Ambulance, Denmark
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18
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Alstrup K, Petersen JAK, Sollid S, Johnsen SP, Rognås L. Mortality and hospitalisation in the Danish Helicopter Emergency Medical Service (HEMS) population from 2014 to 2018: a national population-based study of HEMS triage. BMJ Open 2020; 10:e038718. [PMID: 32868364 PMCID: PMC7462229 DOI: 10.1136/bmjopen-2020-038718] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE To describe characteristics and outcomes for patients where the Danish Helicopter Emergency Medical Service (HEMS) either transported the patient to hospital, treated the patient on scene but did not transport the patient or was dispatched but cancelled en route to the patient (aborted mission), and to assess the field triage by comparing these outcomes. DESIGN National population-based study. SETTING AND PARTICIPANTS HEMS dispatches are undertaken from the five Danish emergency dispatch medical centres according to national guidelines. The study analysed all primary missions with helicopter take off where the patient was admitted to hospital between 1st October 2014 and 30th April 2018. MAIN OUTCOME MEASURES Mortality rates, admittance to an intensive care unit (ICU), need of mechanical ventilation and length of hospital stay (LOS). RESULTS 6931 patients were admitted to hospital; 3311 patients were air lifted, 164 patients were ground escorted by a HEMS physician, 1421 were assisted on scene by HEMS, but escorted by the ground units and 2035 missions were aborted. The mortality was highest among the airlifted and ground escorted patients, and lowest among the patients in the aborted mission group. Mortality for the airlifted patients increased from 8.2% (95% CI; 7.3 to 9.2) at day 1 to 19.5% (95% CI; 18.2 to 20.9) after 1 year. The airlifted and ground escorted patients were frequently admitted to ICU and subsequently mechanically ventilated and they also had an increased LOS compared with the patients only assisted on scene by HEMS and the patients in the aborted mission group. CONCLUSION Patients to whom HEMS are dispatched are often critically ill or injured and have a relatively high mortality. The patients airlifted or ground escorted to hospital by HEMS appear more critically ill or injured compared with the assisted patients and the patients in the aborted mission group. The on-scene triage seems appropriate.
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Affiliation(s)
- Karen Alstrup
- Department of Research and Development, Pre-hospital Emergency Medical Service, Aarhus N, Denmark
| | - Jens Aage Kølsen Petersen
- Department of Anaesthesiology, Aarhus University Hospital, Aarhus N, Denmark
- The Danish Air Ambulance, Aarhus, Denmark
| | - Stephen Sollid
- R&D, Norwegian Air Ambulance Foundation, Drobak, Norway
- Department of Quality and Health Technology, University of Stavanger, Stavanger, Norway
| | - Søren Paaske Johnsen
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, University of Aalborg, Aalborg, Denmark
| | - Leif Rognås
- Department of Anaesthesiology, Aarhus University Hospital, Aarhus N, Denmark
- The Danish Air Ambulance, Aarhus, Denmark
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19
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Saviluoto A, Björkman J, Olkinuora A, Virkkunen I, Kirves H, Setälä P, Pulkkinen I, Laukkanen-Nevala P, Raatiniemi L, Jäntti H, Iirola T, Nurmi J. The first seven years of nationally organized helicopter emergency medical services in Finland - the data from quality registry. Scand J Trauma Resusc Emerg Med 2020; 28:46. [PMID: 32471467 PMCID: PMC7260827 DOI: 10.1186/s13049-020-00739-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 05/20/2020] [Indexed: 12/28/2022] Open
Abstract
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.
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Affiliation(s)
- Anssi Saviluoto
- Research and Development Unit, FinnHEMS, WTC Helsinki Airport, Lentäjäntie 3, FI-01530, Vantaa, Finland. .,University of Eastern Finland, PO Box 1627, FI-70211, Kuopio, Finland.
| | - Johannes Björkman
- Research and Development Unit, FinnHEMS, WTC Helsinki Airport, Lentäjäntie 3, FI-01530, Vantaa, Finland.,University of Helsinki, PO Box 4, FI-00014, Helsinki, Finland
| | - Anna Olkinuora
- Research and Development Unit, FinnHEMS, WTC Helsinki Airport, Lentäjäntie 3, FI-01530, Vantaa, Finland
| | - Ilkka Virkkunen
- Research and Development Unit, FinnHEMS, WTC Helsinki Airport, Lentäjäntie 3, FI-01530, Vantaa, Finland
| | - Hetti Kirves
- Prehospital Emergency Care, Hyvinkää hospital area, Hospital District of Helsinki and Uusimaa, PO Box 585, FI-05850, Hyvinkää, Finland
| | - Piritta Setälä
- Emergency Medical Services, Tampere University Hospital, PO Box 2000, FI-33521, Tampere, Finland
| | - Ilkka Pulkkinen
- Research and Development Unit, FinnHEMS, WTC Helsinki Airport, Lentäjäntie 3, FI-01530, Vantaa, Finland
| | - Päivi Laukkanen-Nevala
- Research and Development Unit, FinnHEMS, WTC Helsinki Airport, Lentäjäntie 3, FI-01530, Vantaa, Finland
| | - Lasse Raatiniemi
- Centre for Prehospital Emergency Care, Oulu University Hospital, PO Box 50, FI-90029, Oulu, Finland
| | - Helena Jäntti
- University of Eastern Finland, PO Box 1627, FI-70211, Kuopio, Finland.,Center for Prehospital Emergency Care, Kuopio University Hospital, PO Box 100, FI-70029, Kuopio, Finland
| | - Timo Iirola
- Emergency Medical Services, Turku University Hospital and University of Turku, PO Box 52, FI-20521, Turku, Finland
| | - Jouni Nurmi
- Research and Development Unit, FinnHEMS, WTC Helsinki Airport, Lentäjäntie 3, FI-01530, Vantaa, Finland.,Emergency Medicine and Services, Helsinki University Hospital and Emergency Medicine, University of Helsinki, PO Box 100, FI-00029, Helsinki, Finland
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Alstrup K, Møller TP, Knudsen L, Hansen TM, Petersen JAK, Rognås L, Barfod C. Characteristics of patients treated by the Danish Helicopter Emergency Medical Service from 2014-2018: a nationwide population-based study. Scand J Trauma Resusc Emerg Med 2019; 27:102. [PMID: 31699120 PMCID: PMC6836366 DOI: 10.1186/s13049-019-0672-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 09/25/2019] [Indexed: 11/23/2022] Open
Abstract
Background A national Helicopter Emergency Medical Service (HEMS) was introduced in Denmark in 2014 to ensure the availability of physician-led critical care for all patients regardless of location. Appropriate dispatch of HEMS is known to be complex, and resource utilisation is a highly relevant topic. Population-based studies on patient characteristics are fundamental when evaluating and optimising a system. The aim of this study was to describe the patient population treated by the Danish HEMS in terms of demographics, pre-hospital diagnostics, severity of illness or injury, and the critical care interventions performed. Method The study is a retrospective nationwide population-based study based on data gathered from the Danish HEMS database. We included primary missions resulting in a patient encounter registered between October 1st 2014 and April 30th 2018. Results Of 13.391 dispatches registered in the study period we included 7133 (53%) primary missions with patient encounter: 4639 patients were air lifted to hospital, 174 patients were escorted to hospital by the HEMS physician in an ambulance, and in 2320 cases HEMS assisted the ground crew on scene but did not escort the patient to hospital. Patient age ranged from 0-99 years and 64% of the population were men. The median age was 60 years. The main diagnostic groups were cardio-vascular emergencies (41%), trauma (23%) and neurological emergencies (16%). In 61% of the cases, the patient was critically ill/injured corresponding to a NACA (National Advisory Committee for Aeronautics) score between 4 and 7 (both included). In more than one third of the missions a critical care intervention was performed. Ultrasound examination and endo-tracheal intubation were the critical care interventions most frequently performed (21% and 20%, respectively). Conclusion The national Danish HEMS primarily attends severely ill or injured patients and often perform critical care interventions. In addition, the Danish HEMS provides rapid transport to highly specialised treatment for patients in the more rural parts of the country. Patients with cardio-vascular emergencies, trauma and neurological emergencies are among those patient groups most commonly seen. We conclude that the overall dispatch profile appears appropriate but emphasise that continuous development and refinement is essential.
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Affiliation(s)
- Karen Alstrup
- Department of Research and Development, Pre-hospital Emergency Medical Services, Central Denmark Region, Olof Palmes Allé 34, 8200, Aarhus N, Denmark.
| | | | - Lars Knudsen
- Department of Anaesthesiology, Aarhus University Hospital, Aarhus, Denmark.,The Danish Air Ambulance, Aarhus, Denmark
| | | | - Jens Aage Kølsen Petersen
- Department of Anaesthesiology, Aarhus University Hospital, Aarhus, Denmark.,The Danish Air Ambulance, Aarhus, Denmark
| | - Leif Rognås
- Department of Research and Development, Pre-hospital Emergency Medical Services, Central Denmark Region, Olof Palmes Allé 34, 8200, Aarhus N, Denmark.,Department of Anaesthesiology, Aarhus University Hospital, Aarhus, Denmark.,The Danish Air Ambulance, Aarhus, Denmark
| | - Charlotte Barfod
- The Danish Air Ambulance, Aarhus, Denmark.,Copenhagen Emergency Medical Services, University of Copenhagen, Aarhus, Denmark
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Lindskou TA, Mikkelsen S, Christensen EF, Hansen PA, Jørgensen G, Hendriksen OM, Kirkegaard H, Berlac PA, Søvsø MB. The Danish prehospital emergency healthcare system and research possibilities. Scand J Trauma Resusc Emerg Med 2019; 27:100. [PMID: 31684982 PMCID: PMC6829955 DOI: 10.1186/s13049-019-0676-5] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 10/02/2019] [Indexed: 11/10/2022] Open
Abstract
The emergency medical healthcare system outside hospital varies greatly across the globe - even within the western world. Within the last ten years, the demand for emergency medical service systems has increased, and the Danish emergency medical service system has undergone major changes.Therefore, we aimed to provide an updated description of the current Danish prehospital medical healthcare system.Since 2007, Denmark has been divided into five regions each responsible for health services, including the prehospital services. Each region may contract their own ambulance service providers. The Danish emergency medical services in general include ambulances, rapid response vehicles, mobile emergency care units and helicopter emergency medical services. All calls to the national emergency number, 1-1-2, are answered by the police, or the Copenhagen fire brigade, and since 2011 forwarded to an Emergency Medical Coordination Centre when the call relates to medical issues. At the Emergency Medical Coordination Centre, healthcare personnel assess the situation guided by the Danish Index for Emergency Care and determine the level of urgency of the situation, while technical personnel dispatch the appropriate medical emergency vehicles. In Denmark, all healthcare services, including emergency medical services are publicly funded and free of charge. In addition to emergency calls, other medical services are available for less urgent health problems around the clock. Prehospital personnel have since 2015 utilized a nationwide electronic prehospital medical record. The use of this prehospital medical record combined with Denmark's extensive registries, linkable by the unique civil registration number, enables new and unique possibilities to do high quality prehospital research, with complete patient follow-up.
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Affiliation(s)
- Tim Alex Lindskou
- Centre for Prehospital and Emergency Research, Department of Clinical Medicine, Aalborg University, Søndre Skovvej 15, 9000, Aalborg, Denmark.
| | - Søren Mikkelsen
- Department of Regional Health Research, University of Southern Denmark, J. B. Winsløws Vej 19, 5000, Odense, Denmark
| | - Erika Frischknecht Christensen
- Centre for Prehospital and Emergency Research, Department of Clinical Medicine, Aalborg University, Søndre Skovvej 15, 9000, Aalborg, Denmark
| | - Poul Anders Hansen
- Emergency Medical Services, North Denmark Region, Hjulmagervej 20, 9000, Aalborg, Denmark
| | - Gitte Jørgensen
- The Prehospital Organisation, The Region of Southern Denmark, Damhaven 12, 7100, Vejle, Denmark
| | - Ole Mazur Hendriksen
- Prehospital Emergency Medical Services, Region Zealand, Fælledvej 1, 4200, Slagelse, Denmark
| | - Hans Kirkegaard
- Department of Research and Development, Emergency Medical Services, Olof Palmes Alle 34, 8200, Aarhus N, Central Denmark Region, Denmark
| | - Peter Anthony Berlac
- Copenhagen Emergency Medical Services, Telegrafvej 5, 2. stairway, 3. floor, 2750, Ballerup, Denmark
| | - Morten Breinholt Søvsø
- Centre for Prehospital and Emergency Research, Department of Clinical Medicine, Aalborg University, Søndre Skovvej 15, 9000, Aalborg, Denmark
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Slagt C, Heijne A, van Geffen GJ. Letter to the editor: in response to Alstrup et. al. Scand J Trauma Resusc Emerg Med 2019; 27:62. [PMID: 31208437 PMCID: PMC6580539 DOI: 10.1186/s13049-019-0638-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 06/05/2019] [Indexed: 11/28/2022] Open
Affiliation(s)
- Cor Slagt
- Department of Anesthesiology, Pain and Palliative care, Radboud University Medical Centre, PO box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Amon Heijne
- Department of Anesthesiology, Pain and Palliative care, Radboud University Medical Centre, PO box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Geert-Jan van Geffen
- Department of Anesthesiology, Pain and Palliative care, Radboud University Medical Centre, PO box 9101, 6500 HB, Nijmegen, The Netherlands
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