EHAC medical working group best practice advice on the role of air rescue and pre hospital critical care at major incidents

Abstract

BackgroundHelicopter EMS (HEMS) teams may perform a variety of clinical, managerial and transport functions during major incident management. Despite national and international variations in HEMS systems, the rapid delivery of HEMS personnel with advanced skills in major incident management and clinical scene leadership has been crucial to the delivery of an effective medical response at previous incidents. This document outlines the Best Practice Advice of the European HEMS and Air Ambulance Committee (EHAC) Medical Working Group on how HEMS and Pre Hospital Critical Care teams may maximise the positive impact of their resources in the event of Major Incidents.MethodsNarrative literature review and expert consensus.ResultsTo ensure a safe, coordinated and effective response, HEMS teams require suitable, proportionate and up to date major incident plans that are integrated into the major incident plans of other regional emergency and healthcare services. Role specific protocols, training and equipment should be adapted to the expected HEMS role in the major incident plan and likely regional threats. System and incident factors will influence HEMS utilisation during the major incident response and can include patient and staff transfer, equipment resupply, aerial assessment, search and rescue, clinical leadership and advanced care. During the recovery phase of a major incident there is a need to ensure restoration of conventional service and address the welfare of involved HEMS personnel. Standardised reporting of major incidents is strongly recommended for clinical governance, legal and research reasons.ConclusionsThe rapid delivery of HEMS personnel with advanced skills in Major Incident management and clinical scene leadership is crucial to the delivery of an effective medical response at Major Incidents.

Advantages and disadvantages of using helicopters for air medical evacuation of victims with traumas (literature review)

“…Вертолеты признаны важным компонентом в системе ликвидации медикосанитарных последствий ЧС, особенно в труднодоступных и удаленных регионах [1,51]. Сообщения об использовании HEMS при ЧС многочислен ны, но разнородны и не систематизированы.…”

“…Вертолеты полезны не только для санитарно авиа ционной эвакуации пациен тов, но так же для перевозки оборудования, предме тов снабжения и персонала спасательных служб, поиска и спасения пострадавших [25]. Европейский комитет здравоохране ния и санитарной авиации (European HEMS and Air Ambulance Committee -EHAC) [51] и Международная комиссия по горной меди цине (International Commission for Mountain Emergency Medicine -ICAR MEDCOM) [11] представили научно обоснованные, но общие рекомендации по использованию HEMS при ЧС и в горноспасательных операциях. В гор ных районах следует учитывать необходи мость специального оборудования для подъ е ма травмированных на вертолет; важность раннего оказания помощи пострадавшим от схода лавин, гипотермии, удара молнии; вла дение медперсонала навыками реанимацион ной помощи, так как до 53 % эвакуируемых с тяжелыми травмами имеют критические нарушения жизненно важных функций [9].…”

Helicopter emergency medical services in sudden-onset major incidents ; Patterns of use

“…(104) HEMS role in major incident management is integrated in the medical response and include swift deployment of extra staff and equipment, medical treatment, triage, air surveillance, search and rescue, access to remote sites and medical evacuation. (88,105) Although the use of HEMS may be beneficial, challenges were also associated with the use of HEMS: (103) effects of this hazard in an efficient manner. (111) The UN general assembly endorsed the Sendai Framework in 2015 that aims for: a "substantial reduction of disaster risk and losses in lives, livelihoods and health and in the economic, physical, social, cultural and environmental assets of persons, businesses, communities and countries."…”

“…The need to integrate HEMS into major incident and disaster response has been highlighted previously, but the question on optimal use remains scarcely described in structured research. (88,104) Heterogenous case reports and evaluations dominate both indexed and non-indexed literature. (2, 78, 116)…”

“…Multiple HEMS units and insufficient air traffic control should be addressed with specific procedures with clear rules for communication and command to ensure aviation safety. (2,88) The enhanced use of drones for surveillance of incident sites may increase operational awareness, but also represent a risk of collisions with other aircrafts. (186) Approximately half of the pilots in the survey coordinated other HEMS units, a contribution that probably will grow in importance as the use of drones makes air-crowding a greater challenge.…”