Are physicians required during winch rescue missions in an Australian helicopter emergency medical service?

Abstract

Our high POI rate of 40% (48/120) coupled with long rescue times and the occasional severe injuries support the argument for winching Physicians. Not doing so would deny a significant proportion of patients time-critical interventions, advanced analgesia and procedural sedation.

Pain Management Strategies and Time Spent on Scene for Pre-Hospital Analgesia Provision in an Alpine Environment: A Retrospective Study

“…The maximal dose of midazolam reported in our study was lower than in another study [16]. This difference may be due to more cautious dosing related to greater safety concerns in mountain rescue [25]. Among patients who received ketamine and midazolam, 89% also benefitted from fentanyl, although this triple therapy may increase the risk of adverse events.…”

“…Finally, the median previously published scene times for winching missions from two other studies were of 42.5 and 48 minutes [25,40] respectively, which was twice as long as the scene time of winching missions in our study. This could be explained by differences in operating procedures, terrain, or the mix of patient cases.…”

Review article: Primary aeromedical retrievals in Australia: An interrogation and search for context

“…11 AIS, Abbreviated Injury Score; GOS, Glasgow Outcome Scale; GSA, Greater Sydney Area; HEMS, Helicopter Emergency Medical Services; HIRT, Head Injury Retrieval Trial; ICU, intensive care unit; ISS, Injury Severity Score; NIPPV, noninvasive positive-pressure ventilation; NSW, New South Wales; REMS, Rapid Emergency Medicine Score; RTS, Revised Trauma Score; SAPS-2, Simplified Acute Physiology Score; TISS, Therapeutic Intervention Scoring System. Level II (n = 2) 22,24 Level II (n = 2) 22,24 Level III-2 (n = 3) 20,26,44 Level III-2 (n = 2) 28,41 Level III-2 (n = 1) 41 Level IV (n = 11) 12,15,16,25,[29][30][31]33,34,39,43 Level IV (n = 16) 11,13,14,[17][18][19]21,27,32,35,37,38,40,42,45 Level IV (n = 9) 2,13,21,31,35,37,45,46 Quality Reasonable (n = 5) …”

“…Standard P value [P < 0.05] (n = 6) ‡ 12,15,16,26,29,43 Standard P value [P < 0.05] (n = 14) ‡ 13,14,[17][18][19]21,22,24,28,32,37,38,41,45 Standard P value [P < 0.05] (n = 9) ‡ 13,21,22,24,37,41,45,46 †Garner 2013 was not included in this table as it is a methodology/protocol overview. Systems category Pugh (2002) was not included in evidence level (due to qualitative methodology).…”

Ventilatory choices for intubated patients during helicopter stretcher winching

“…Winching intubated and ventilated patients is an uncommon event. Sydney Helicopter Emergency Medical Service (HEMS) winched five intubated patients out of 120 winches with a physician over a 30 month period . A Swiss helicopter rescue service intubated and ventilated 16 of 921 winch cases over 6 years .…”