Helicopter Emergency Medical Services (HEMS): Impact on On-Scene Times

Ringburg, A.N.; Spanjersberg, W. Richard; Frankema, Sander P.G.; Steyerberg, Ewout W.; Patka, P.; Schipper, Inger B.

doi:10.1097/01.ta.0000240449.23201.57

Cited by 91 publications

(82 citation statements)

References 19 publications

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“…This paper was submitted without consulting the two trauma centers with an HEMS which prehospitally treated the patients involved in this study. Furthermore, previous papers [2,3,4] from other trauma centers showed conclusions that are very different to this study. Since this article is based on research on the effectiveness of the HEMS in the Netherlands, and the research was performed neither with involvement, nor information of one of the four HEMS stations, we like to make some remarks on this article from the perspective of the four HEMS stations.…”

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confidence: 53%

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Benefit of Helicopter Emergency Medical Services on trauma patient mortality in the Netherlands?

Hoogerwerf

Valk

Houmes

et al. 2013

Injury

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Recently we received the following publication in this Journal: The effect of Helicopter EmergencyMedical Services on trauma patient mortality in the Netherlands, by de Jongh et al. [1]. We have read this article with a higher than normal level of interest as this directly appeals to our field of work and a few serious questions were raised at (all) the four HEMS centres in the Netherlands.First of all, the title of the paper suggests that the study represents the national situation, while in fact it is a single center study and therefore these data cannot by definition be extrapolated to the whole country. This paper was submitted without consulting the two trauma centers with an HEMS which prehospitally treated the patients involved in this study. Furthermore, previous papers [2,3,4] from other trauma centers showed conclusions that are very different to this study. Since this article is based on research on the effectiveness of the HEMS in the Netherlands, and the research was performed neither with involvement, nor information of one of the four HEMS stations, we like to make some remarks on this article from the perspective of the four HEMS stations.In their observational study, the authors conclude that 'HEMS treatment is associated with a nonsignificantly higher risk of in-hospital mortality for patients with TBI and a non-significantly lower risk for patients without TBI'. The adjusted OR's are 1.3 (95% CI 0.6-2.7) and 0.9 (95% CI 0.3-2.5) and since both the 95% CI's contain 1 (as do all 95% CIs in their study), indeed there is no statistical significance. The authors use the words non-significantly higher/lower risk to indicate this in their statement. But when using statistics to test for significance of findings and no statistical significance is found, only speculative conclusions can be drawn.Regarding methodology, we would also like to suggest that, to assess a possible effect of HEMS+EMS vs EMS-only on trauma patient mortality, investigators should stratify or adjust for EMS 'scoop and run' to regional hospitals (of a lower level of care) for primary stabilization and subsequent secondary transport to the definitive care facility (level I trauma centre with neurosurgical service).Also, in case of HEMS+EMS, delivery to regional hospitals can be omitted since primary stabilization takes place at the scene or 'en route' and patients are directly delivered to the level 1 trauma centre.Excluded from analysis, as described in methods, are patients who were directly transferred from the ED to another hospital. However, the authors do not provide information on the number of patients that have been excluded for this reason, and, if any, for what reason. As in the introduction it is stated that the regional hospitals in the county (Noord-Brabant) are capable of resolving acute problems. But it is unclear from the data provided what the level of care of these hospitals is, and whether or not they are adequately staffed for trauma care 24/7 within the time interval given.Selective transfer of patients that o...

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confidence: 53%

“…Table 1 showed us the dispatch criteria for HEMS, but the reality in the Netherlands is that only a few of the accidents present on the list result in an activation of the HEMS, as Ringburg etal. [3] showed earlier that only in 14% of the indications a HEMS has been activated. Lemson etal.…”

Section: Recently We Received the Following Publication In This Journmentioning

confidence: 99%

Benefit of Helicopter Emergency Medical Services on trauma patient mortality in the Netherlands?

Hoogerwerf

Valk

Houmes

et al. 2013

Injury

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“…[2] When comparing the mean on-scene times of both the Netcare 911 HEMS operations with other similarly staffed operations, the mean on-scene times for the Netcare operations were often shorter. [7,20,21] An interesting finding was the similarity between the interfacility transfer and primary transfer on-scene times. The transfer times from scene to hospital for both the Netcare 911 HEMS operations were similar to another SA study.…”

Section: Discussionmentioning

confidence: 99%

An analysis of patients transported by a private helicopter emergency medical service in South Africa

Muhlbauer

Hardcastle

2016

S Afr Med J

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Background.A helicopter emergency medical service (HEMS) is a specialist flying emergency service where on-board medical personnel have both the knowledge and equipment to perform complicated medical procedures. The paucity of literature describing the types of patients flown by HEMS in South Africa (SA) and their clinical outcome poses a challenge for current aeromedical services, as there is no baseline information on which to base flight criteria, staffing and policy documents. This has the potential to hamper the advancement of HEMS in SA. Objectives. To undertake a descriptive analysis of patients flown by the Netcare 911 HEMS over a 12-month period in Gauteng and KwaZulu-Natal (KZN) provinces, SA, and to assess patient outcomes. The clinical demographics of patients transported by the HEMS were analysed, time frames from dispatch of the helicopter to delivery of the patient to the receiving hospital determined, and patient outcomes at 24 hours and 72 hours analysed. Methods. The study utilised a retrospective quantitative, descriptive design to analyse patients transported by a private HEMS in SA. All complete records of patients transported by the Netcare 911 HEMS between 1 January and 31 December 2011 were included. Results. The final study population comprised 537 cases, as 10 cases had to be excluded owing to incomplete documentation. Of the 537 cases, 82 (15.3%) were managed by the KZN HEMS and 455 (84.7%) by the Gauteng HEMS. Adult males were the patients most commonly flown in both Gauteng and KZN (350/455 patients (76.9%) in Gauteng and 48/82 (58.5%) in KZN were males, and 364/455 patients (80.0%) in Gauteng and 73/82 (89.0%) in KZN were adults). Motor vehicle collisions were the most common incidents necessitating transport by HEMS in both operations (n=193, 35.9%). At the 24-hour follow-up, 339 patients (63.1%) were alive and stable, and at the 72-hour followup, 404 (75.3%) were alive and stable. Conclusions. The study findings provided valuable information that may have an impact on the current staffing and authorisation criteria of SA HEMS operations.

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“…However, many studies have described that doctor‐staffed helicopter use is beneficial for patients with cardiac arrest,5 trauma,1, 2, 3, 4, 6, 7, 8, 9 stroke,10, 11 and acute coronary syndrome 12. This research has reported a decrease in mortality rates and a reduction in the time to tertiary treatment for critically ill patients.…”

Section: Discussionmentioning

confidence: 99%

“…According to our survey, 68% of patients with these four diseases were treated by a doctor‐staffed ambulance, although various criteria were used. However, a few studies have denied any benefits for trauma patients13 and have cautioned regarding longer on‐scene times 9…”

Section: Discussionmentioning

confidence: 99%

Overview of doctor‐staffed ambulance use in Japan: a nationwide survey and 1‐week study

Igarashi

Yokobori

Yamana

et al. 2018

Acute Medicine & Surgery

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AimIn Japan, standard prehospital care is provided by emergency medical services teams. Doctor‐staffed ambulances play a role in facilitating the immediate treatment of critically ill patients to increase the survival rates. However, little is known about their activities. We revealed the present situation of doctor‐staffed ambulances in Japan.MethodsFirst, we surveyed all the fire departments in Japan and determined whether a doctor‐staffed ambulance was present within their district boundary. Second, we surveyed hospitals that operate doctor‐staffed ambulances in their system to list their activities during a 1‐week period.ResultsOf 133 hospitals that operated a doctor‐staffed ambulance, 73 (55%) replied to our questionnaire. Only 26 (36%) of them provided 24‐h ambulance deployment. Additionally, 51 (70%) of hospitals bore the operational costs of ambulances. Within 1 week, 345 doctor‐staffed ambulances were dispatched, but 97 (28%) were cancelled. In total, 62 patients (28%) were diagnosed with cardiac arrest, 48 (19%) with trauma or burns, 36 (15%) with stroke, and 22 (9%) with acute coronary syndrome; 159 (58%) were transferred to a tertiary emergency medical center.ConclusionsDoctor‐staffed ambulances have the advantage of deployment at night and in urban areas compared to doctor‐staffed helicopters. Among the 73 hospitals that responded to the questionnaire, doctor‐staffed ambulances were dispatched almost as frequently as doctor‐staffed helicopters. However, doctor‐staffed ambulances did not receive adequate funding. Future data collection is necessary to determine the efficacy of doctor‐staffed ambulances among hospitals that operate this service.

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Helicopter Emergency Medical Services (HEMS): Impact on On-Scene Times

Abstract: Combined EMS/HEMS assistance at an injury scene is associated with longer OST. When corrected for severity of injury and patient characteristics, no influence of longer OST on mortality could be demonstrated.

Cited by 91 publications

References 19 publications

Benefit of Helicopter Emergency Medical Services on trauma patient mortality in the Netherlands?

Benefit of Helicopter Emergency Medical Services on trauma patient mortality in the Netherlands?

An analysis of patients transported by a private helicopter emergency medical service in South Africa

Overview of doctor‐staffed ambulance use in Japan: a nationwide survey and 1‐week study

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