The effect of the Cornwall and Isles of Scilly helicopter ambulance unit on the ambulance services'' ability to deliver acutely traumatized patients to hospital.

Objective: to determine whether the use of a helicopter ambulance unit enabled an ambulance service to deliver acutely traumatized patients to hospital more quickly. Design: retrospectively collected ambulance service and hospital records data analysed longitudinally. Settings: The ambulance service and the major casualty department in Cornwall. Intervention: the provision of a helicopter ambulance unit to a county ambulance service. Subjects: patients with compound lower limb fractures carried as emergencies by an ambulance service. Principle outcome measure: ambulance 'mission times'. Results: the ambulance services' ability to deliver emergency patients to hospital more quickly when the helicopter unit was available was not demonstrated. In some instances availability of the helicopter unit probably delayed the timely delivery of emergency patients to the casualty department. Conclusion: until a more effective helicopter deployment strategy is in operation it is unlikely that mission time savings will occur.     

Effect of physician-staffed helicopter emergency medical service on blunt trauma patient survival and prehospital care.

OBJECTIVE: The aim of the study was to assess the immediate and long-term effect of a helicopter emergency physician giving advanced life support on-scene compared with conventional load and go principle in urban and rural settings in treating blunt trauma patients. METHODS: In a retrospective study, 81 blunt trauma patients treated prehospitally by a physician-staffed helicopter emergency medical service were compared with 77 patients treated before the era of the helicopter emergency medical service. The data were collected in the prehospital and hospital files and a questionnaire was sent to the survivors 3 years after the trauma. RESULTS: The physicians treated the patients more aggressively (gave drugs, intubated and cannulated) and had the patients transported directly to a university hospital. The given treatment did not delay arrival at the hospital. No statistically significant difference was found, but a trend (P = 0.065) to lower survival in the helicopter emergency medical service group. Almost half of the deaths in the helicopter emergency medical service group and none in the control group, however, occurred in the emergency department. No difference was found 3 years later between the groups in the health-related quality of life or decrease in the income owing to the accident. CONCLUSION: The physicians treated the patients more aggressively, but it did not delay the arrival at the hospital. A beneficial effect of this aggressive treatment or direct transport to a university hospital could not be seen in the immediate physiological parameters or later health-related quality of life. The physician-staffed helicopter emergency medical service was not beneficial to blunt trauma patients in this setting.     

The helicopter emergency medical service and essential related nursing skills

Nurses play a critical role in Taiwan's helicopter emergency medical service, an essential healthcare response service for residents of outlying islands. The care skillsets required of nurses in special care and urgent care environments are significantly more specialized than those in other professional care environments. This article discusses the development of the civil helicopter emergency medical service (HEMS) and elements essential to HEMS nursing care efficacy. These elements can be grouped under the categories of pre-flight preparation, assessment for flight-readiness and in-flight care, decision-making abilities, personal physical characteristics, training and experience. These categories should be referenced to improve the effectiveness of relevant education / training programs, enhance HEMS nurse readiness and effectiveness, and maximize the role of HEMS nurses in the civil helicopter medical service.     

The integration of a helicopter emergency medical service in a mass casualty response system

Since 1985, the state of Connecticut has been served by a hospital-based, advanced life support (ALS) helicopter air medical service. The service is stationed at a 1,000-bed, Level 1, trauma center that is responsible for its operation. Connecticut statute requires the hospital to file operations reports with the Office of Emergency Medical Services, which reports to the Connecticut Department of Public Health. Operations include response to requests for transportation of severely ill or injured patients from the scene of an incident, and patient transport from one hospital to a higher level, definitive-care hospital. This service also was charged to develop a disaster response plan to be integrated into the overall state plan for disaster responses. The helicopter disaster response involves all six New England states and three hospital-based emergency medical helicopter programs that operate in the New England states. This approach has allowed for joint planning and multi-agency, simulated drills. The helicopter emergency medical service has responded to 15 simulated emergencies (drills) and seven actual mass casualty incidents from May, 1985 to June, 1989. In Connecticut, the planning process conducted by the Department of Public Health and the Office of State EMS produced a coordinated, multi-jurisdictional, mass-casualty response plan.     

直升机与城市创伤急救系统

直升机转运患者具有快速、灵活、不受地形条件限制,与地面运送相比,空运途中的＂致伤性＂大为减少,但直升机转运在城市创伤急救系统中的作用仍然存在争议。本文旨在分析国内外相关研究的基础上,结合本中心空中急救医疗队伍建设,对目前空中急救体系存在的问题进行探讨和总结,以资对我国空中急救事业的发展提供借鉴。     

Helicopter use in rural trauma

Objective: To profile a helicopter emergency medical service in rural Australia. To assess patient injury severities and outcomes. To compare missions involving ambulance officers with physicians. To determine any time advantage of the aircraft over ground transfer. Methods: Intention‐to‐treat analysis using retrospective case note review of all helicopter emergency medical service trauma patients from January 2004 to November 2006. Global positioning system mapping technology was used to compare one‐way road transfer times with two‐way helicopter retrieval. Results: Two hundred and twenty‐two missions were identified from the helicopter log. Forty missions were aborted in flight. Of 182 patients transported, 11 records were incomplete, leaving 171 for analysis. Fifty (29%) patients transported had an Injury Severity Score (ISS) > 15; the average ISS was 12.30 (standard error of the mean 0.82). The average calculated distance flown was 160.4 nautical miles (standard error of the mean 5.29; range 28–360 nautical miles). There was no significant difference in ISS between ambulance officers and physician groups (t = ?1.17, P = 0.25, 95% CI ?7.37–1.91). There was no difference in the incidence of severe injury (ISS > 15, P = 0.39) or mortality (P = 0.33) when the groups were compared. Air transport was significantly faster beyond 100 km, with a mean difference of 48 min (P = 0.00). Conclusion: We could not identify a significant survival benefit attributable to the addition of a doctor, although numbers for this comparison were small. Predicting missions where flight physicians might provide benefit remain imprecise and should be a priority area for prospective evaluation. We have demonstrated that in the absence of special circumstances, a helicopter response within 100 km from base does not improve time to definitive care.     

Helicopter use by rural emergency departments to transfer trauma victims: a study of time-to-request intervals

To assess how soon rural emergency departments (EDs) call for helicopters to transport seriously injured patients, the records of all trauma victims (excluding isolated CNS trauma) transported by an emergency helicopter service from referring hospitals to a trauma center over an 18-month period were studied. Admission time to the referring ED was compared with the exact time a call for the helicopter was received and a time-to-request interval (TTR) was calculated. A total of 64 cases were studied. Fifty (78%) of the patients had blunt trauma; 14 (22%) had penetrating trauma. The average TTR for the helicopter was 69.8 minutes, with a range from 17 minutes before arrival at the referring ED to 337 minutes after arrival. Children (aged less than or equal to 16 years) had an average TTR of 34.1 minutes compared with 76.4 minutes for adults (aged greater than 16 years). Of the variables examined, patient age was the only factor significantly associated with TTR. These observations suggest that, except in children, there frequently is a lengthy time interval between the time trauma patients arrive at EDs in rural eastern North Carolina and the time an emergency helicopter service is called to transport them to a trauma center.     

Air medical transport utilization review in North Carolina

Objective: To perform a review of the collective experience of all hospital-based helicopter ambulances in the state of North Carolina for compliance with utilization review criteria. Design: Flight records of the six members of the North Carolina Aeromedical Affiliation for the months of November and December 1989 were compared with utilization review criteria by an independent reviewer. A secondary review was performed by a staff member for each service. Scene responses and patients flown to a hospital other than the sponsor were evaluated. Setting: All six hospital-based helicopter services in North Carolina. Type of participants: All available flight records for November and December 1989. Interventions: None. Measurements and main results: Of 756 transports, 747 flight records were available for review. Initial review demonstrated compliance with the criteria for 713 (95.4%) patients; secondary review showed compliance for 18 of 34 flights not meeting initial review, for an overall compliance rate of 97.9%. Compliance rates for scene responses and transports taken to a hospital other than the sponsoring facility were 96.6% and 94.1%, respectively. Conclusions: Review of all flights over a period of two-months by all six hospital-based helicopter services in North Carolina using utilization review criteria demonstrated a very high rate of compliance with the established criteria.     

An ambulance helicopter for emergency calls.

The use of a helicopter as a primary response vehicle for the Cornwall Ambulance Service is presented. A brief analysis of the activities of the First Air Ambulance is described and an appraisal of its effects on the overall performance of the Service is given. Emphasis is given to patient acceptability and also to the flexibility of the helicopter in terms of its response to different situations. In conclusion, The Air Ambulance, as part of an integrated ambulance service, is an effective provider of good pre-hospital care.     

Hospital and flight program reimbursement for patients transferred by helicopter

To determine the reimbursement status of a helicopter aeromedical program and its sponsoring hospital, the financial records of all patients transported by a university hospital-based helicopter aeromedical service during a one-year period of time were examined. The flight program was able to collect only 43% of patient charges, recouping only 24% of its operating costs. The hospital collected 57% of its total charges to patients transported by the helicopter aeromedical program. Reimbursers paying on a per-diem basis comprised 36% of the payors and had collection rates of 50% and 10% for the hospital and flight program, respectively. Cost-based insurers constituted 20% of the payors, provided 44% of program revenue, and had collection rates of 92% for the hospital and the flight program. If cost-based payors had reimbursed on rates similar to the per-diem payors, the hospital would have recovered only 49% of its charges and the flight program, would have recovered only 26% of its charges, recouping only 15% of its operating costs. In conclusion, reimbursement for helicopter aeromedical services and for the care provided to aeromedically transferred patients is poor. Sponsoring institutions are consequently subjected to significant financial stress that possibly challenges the fiscal viability of some programs.     

Integrated locating of helicopter stations and helipads for wounded transfer under demand location uncertainty

Health emergency medical service (HEMS) plays an important role in reducing injuries by providing advanced medical care in the shortest time and reducing the transfer time to advanced treatment centers. In the regions without ground relief coverage, it would be faster to transfer emergency patients to the hospital by a helicopter. In this paper, an integer nonlinear programming model is presented for the integrated locating of helicopter stations and helipads by considering uncertainty in demand points. We assume three transfer modes: (1) direct transfer by an ambulance, (2) transfer by an ambulance to a helicopter station and then to the hospital by a helicopter, (3) transfer by an ambulance to a predetermined point and then to the hospital by a helicopter. We also assume that demands occur in a square-shaped area, in which each side follows a uniform distribution. It is also assumed that demands in an area decrease errors in the distances between each two cities. The purpose of this model is to minimize the transfer time from demand points to the hospital by considering different modes. The proposed model is examined in terms of validity and applicability in Lorestan Province and a sensitivity analysis is also conducted on the total allocated budget.     

Differences in mortality rates among trauma patients transported by helicopter and ambulance in Maryland

INTRODUCTION: A comprehensive state-wide emergency medical services and helicopter transport system has been developed in the State of Maryland on the principle that early definitive care improves patient outcomes. The purpose of this study was to determine if empirical data exist to support the theory that air medical transportation services provided by the Maryland State Police (MSP) Aviation Division contribute to an improved trauma patient survival rate in Maryland. METHODS: A retrospective study was conducted on the records of all patients transported by helicopter or ground ambulance and admitted to the R Adams Cowley Shock Trauma Center (STC) of the University of Maryland Medical System. Data were obtained from the Maryland Institute of Emergency Medical Services Systems (MIEMSS) Shock Trauma Clinical Registry for the period January 1988 through July 1995, covering 23,002 patients. Patients included those transported directly from the scene of injury to the STC as well as those from interfacility transfers. All patients were stratified by injury severity and compared by outcome (mortality) using Mantel-Haenszel statistics. RESULTS: During the study period, 11,379 patients were transported by ground and 11,623 were transported by MSP helicopter. The mean Injury Severity Score (ISS) for patients transported by ground was 12.7 (SD = 12.52) and the mean ISS for patients transported by air was 14.6 (SD = 13.42), p < 0.001. Among patients classified as having a high index of injury severity, the mortality rate was lower among those transported by MSP helicopter than among those transported by ambulance. The mortality rate was significantly lower for air transported patient with an ISS higher than 31. CONCLUSION: The State of Maryland has demonstrated a commitment to its citizenry and invested heavily in its public safety air medical service. This study suggests the rapid air transport of victims of traumatic events by specialized personnel in Maryland has a positive effect on the outcome of severely injured patients. Further research is necessary to clarify the causal relationships in order to more fully elucidate the value of this resource.     

E FFECTS OF A C ONTINUOUS Q UALITY I MPROVEMENT P ROGRAM ON H ELICOPTER L IFTOFF T IMES

Background. The continuous quality improvement (CQI) process addresses concerns from a systems approach, employing committees of employees rather than selected management personnel to identify and solve problems, improve patient care and efficiency, and enhance customer satisfaction. Little is known about the effects of the CQI process on an aeromedical program. Objectives. To create a CQI program within an aeromedical program and to investigate its effect on helicopter liftoff times for scene responses. Methods. A CQI program was established at a busy aeromedical service that completed 897 missions in the previous year. A concern identified by the CQI committee was delays in helicopter liftoff time after receipt of mission requests for scene responses. Each component necessary for liftoff (dispatch, pilot weather check, and crew response) was identified, time limits were set for each, new procedures were developed, and all staff received training on the new procedures. Computer tracking of each of the identified component times allowed comparison of data pre and post procedure implementation of the CQI-developed procedures. Results. After CQI changes in procedures were implemented, there were a total of 30 delays out of 323 calls (9% of liftoffs for on-scene flights). This represents a 6% reduction in total delays. The largest drop in component times was observed in crew response (2.6%). An unanticipated 10% drop in response times for interhospital liftoffs also occurred, presumably due to heightened awareness of the service to response times in general. Conclusions. These findings suggest that employing a program utilizing CQI concepts can shorten helicopter liftoff times and improve response times in aeromedical programs.     

How safe are HEMS-programmes in Germany? : A retrospective analysis

INTRODUCTION: Recent accidents with helicopter emergency medical service (HEMS) aircraft raise the question how safe HEMS in Germany is and how accidents could be prevented. MATERIALS AND METHODS: We surveyed all German HEMS-programmes and reviewed the data of the German Aviation Authority regarding accidents with HEMS. RESULTS: An average German HEMS-programme encounters one accident leading to at least severe damage or loss of the helicopter in 26 operating years, one accident resulting in casualties in 65 operating years and one fatal accident in 111 operating years. The major causes of accidents were obstacle strikes during landing at the scene. Flying in bad weather conditions and lack of discipline were other factors contributing to HEMS-accidents. CONCLUSION: HEMS-safety could be improved by special training programmes for pilots and HEMS-crewmembers to address the factors listed above. Safety training for doctors is recommended but we did not find support for the notion of changing the doctor's legal position of a passenger to a HEMS-crewmember.     

Factors associated with the safety of EMS helicopters

The accident rate for emergency medical service (EMS) helicopters is thought to be approximately twice the rate for other commercial (Part 135) helicopters. This observation has led to numerous news reports and to the publication of conclusions of a National Transportation Safety Board investigation. The data for these reports come from investigations of EMS helicopter accidents and incidents. The authors surveyed all listed civilian EMS helicopter programs to examine both helicopter ambulance mishaps and the number of safely completed missions. Epidemiological methods were then used to compare the safety records of different groups of EMS helicopters. The single most important factor identified was the number of flights made by the program during the study period: busy programs had an eightfold lower accident rate (P less than .0005) and a three-fold lower total mishap (accidents + incidents) rate (P less than .0005) than less active programs. Programs with the ability to fly under instrument flight rules (IFR) at the pilots discretion had no mishaps (P = .044) during the study period. Multivariate analysis shows this IFR capability to be marginally significant as an independent factor (P = .099).     

Incidence of desaturation during prehospital rapid sequence intubation in a physician-based helicopter emergency service

Background

Hypoxemia may occur during rapid sequence intubation (RSI). This study establishes the incidence of this adverse event in patients intubated by physicians in a helicopter emergency service in Norway.

Methods

This was a prospective, observational study of all RSIs performed by helicopter emergency service physicians during a 12-month period. Hypoxemia was defined as a decrease in Spo₂ values to below 90% or a decrease of more than 10% if the initial Spo₂ was less than 90%.

Results

A total of 122 prehospital intubations were performed during the study period. Spo₂ data were available for 101 (82.8%) patients. Hypoxemia was present in 11 (10.9%) patients.

Conclusions

Prehospital, RSI-related hypoxemia rates in this study are lower than reported rates in similar studies and are comparable with in-hospital rates. Prehospital RSI may accordingly be considered a safe procedure when performed by experienced physicians with appropriate field training.     

The use of rapid sequence intubation by ambulance paramedics for patients with severe head injury

Objective: To determine the effects of rapid sequence intubation in patients with severe head injury performed by paramedics on a helicopter emergency medical service. Methods: The patient care records for patients with severe head injury who underwent rapid sequence intubation between November 1999 and February 2002 (inclusive) were examined. Data were extracted on the demographics of the patients, as well as the physiological changes before and after rapid sequence intubation. Results: There were 122 patients with severe head injury evaluated at the scene during the study period. Rapid sequence intubation was attempted in 110 patients and was successful in 107 (97%). Intubation was associated with improvements in systolic blood pressure, oxygen saturation and end‐tidal carbon dioxide levels, compared with baseline levels. Conclusion: Rapid sequence intubation in patients with severe head injury may be safely undertaken by helicopter‐based ambulance paramedics and is associated with improvements in oxygenation, ventilation and blood pressure. Further studies of this skill undertaken by road‐based paramedics are warranted.     

A helicopter flight does not induce significant changes in systemic biomarker profiles

Whole‐body vibration and noise are inherent characteristics of helicopter operations. The helicopter pilot is affected by vibration from both low‐frequency noise and mechanical vibration sources. The way this energy is transmitted to different tissues and organs depends on intensity, frequency and resonance phenomena within the body. Whole‐body vibration is known to affect the muscular and skeletal system in the lower part of the spine, but less is known about the response at the cellular level to this stimulation. In some studies, chronic pathological changes have been described in different types of tissue in people exposed to low‐frequency noise and vibration. The aim of the present study was to investigate possible cellular reactions to acute exposure to low‐frequency noise and vibration in a helicopter. Thirteen healthy males aged 38 (18–69) years were subjected to a 3.5 h helicopter flight in a Westland Sea King Rescue helicopter. Blood tests taken before and after the flight were analysed for more than 40 parameters, including acute phase reactants, markers of leucocyte and platelet activation, complement and hemostasis markers, as well as a broad panel of cytokines, chemokines, growth factors and cell adhesion molecules. The subjects served as their own controls. With the exception of an increase in vascular cell adhesion molecule‐1 (VCAM‐1) during the flight, no statistically significant changes in the biomarkers were found after controlling for diurnal variation in the control blood tests, which were observed independently of the helicopter flight. In conclusion, one helicopter flight does not induce measurable changes in systemic biomarkers.     

The Effect of Adding a Second Helicopter on Trauma-Related Mortality in a County-Based Trauma System

Objectives. Despite conflicting evidence regarding its efficacy, helicopter transportation of trauma victims is widespread. We determined the effect of adding a second helicopter to a countywide emergency medicine system on trauma-related mortality. Methods. A before-and-after trial design was used to compare hospital mortality before and after introducing a second helicopter to the eastern end of Suffolk County, New York, in 2001 aimed at reducing transport times to the regional trauma center. Outcomes before and after introducing the second helicopter were compared with parametric or nonparametric tests as appropriate. Results. A total of 1,551 trauma patients were included in this study from June 1996 to May 2006, with 705 in the single-helicopter period and 846 in the two-helicopter period. Mean ages, gender distributions, and mean Injury Severity Scores (ISSs) were similar between groups. Total mortality significantly decreased after the addition of the second helicopter (16.2% before vs. 11.9% after; p = 0.02). Conclusions. Introduction of a second helicopter to the east end of Long Island was associated with a significant reduction in the total trauma mortality.     

Critical cardiac transport: air versus ground?

The helicopter transport of acute cardiac patients has become increasingly common, although no study has examined solely the effect of such transport on outcome in this subset of patients. A combined air and ground critical care transport service provided the opportunity for a direct comparison of patients with acute cardiac conditions (myocardial infarction or unstable angina) transported either by our helicopter or by a specially equipped critical care ground vehicle. Both air and ground components were similarly equipped in terms of personnel and medical equipment. Seventy-eight (27 ground, 51 air) transport cases were studied. Both patient groups were comparable in terms of age, sex, Killip classification, and diagnosis. Serious untoward events, defined as arrhythmias, chest pain, hypotension, bradycardia, seizures, and cardiac arrest, occurred in 41% of air transports and 7.5% of ground transports (P less than .002). The overall incidence of untoward events was also significantly greater with air transports (25/51, or 49%) than with the ground vehicle (4/27, or 15%; P less than .005). The reasons for these differences are unknown.