Identification of the technical and medical requirements for HEMS avalanche rescue missions through a 15-year retrospective analysis in a HEMS in Switzerland: a necessary step for quality improvement

Abstract

BackgroundAvalanche rescues mostly rely on helicopter emergency medical services (HEMS) and include technical rescue and complex medical situations under difficult conditions. The adequacy of avalanche victim management has been shown to be unexpectedly low, suggesting the need for quality improvement. We analyse the technical rescue and medical competency requirements of HEMS crewmembers for avalanche rescue missions, as well as their clinical exposure. The study aims to identify areas that should be the focus of future quality improvement efforts.MethodsThis 15-year retrospective study of avalanche rescue by the Swiss HEMS Rega includes all missions where at least one patient had been caught by an avalanche, found within 24 h of the alarm being raised, and transported.ResultsOur analyses included 422 missions (596 patients). Crews were frequently confronted with technical rescue aspects, including winching (29%) and patient location and extrication (48%), as well as multiple casualty accidents (32%). Forty-seven percent of the patients suffered potential or overt vital threat; 29% were in cardiac arrest. The on-site medical management of the victims required a large array of basic and advanced medical skills. Clinical exposure was low, as 56% of the physicians were involved in only one avalanche rescue mission over the study period.ConclusionsOur data provide a solid baseline measure and valuable starting point for improving our understanding of the challenges encountered during avalanche rescue missions. We further suggest QI interventions, that might be immediately useful for HEMS operating under similar settings. A coordinated approach using a consensus process to determine quality indicators and a minimal dataset for the specific setting of avalanche rescue would be the logical next step.Electronic supplementary materialThe online version of this article (10.1186/s13049-018-0520-3) contains supplementary material, which is available to authorized users.

Helicopter Emergency Medical Service (HEMS) Response in Rural Areas in Poland: Retrospective Study

“…In this study, the number of male patients, and patients aged 50–64 years with an average age of 48.87 years was significantly higher. Similar demographic features were obtained by other authors analyzing interventions by helicopter medical rescue service crew—Østerås et al (2017), Kottmann et al (2018), Norum and Elsbak (2011) [22,23,24]. Although the studies by Mathiesen et al (2018), McMullan et al (2012), Baker and McKay (2010), and Christensen et al (2017) also showed that male group patients was significantly higher in number, the mean age of patients in their study was higher than identified in this report [25,26,27,28].…”

Missions of the Helicopter Emergency Medical Service in rural and urban areas in Poland – A comparative retrospective analysis

“…The analysed group of patients consisted mainly of males who made up two-thirds of the entire group, and persons aged 50-64, mean age of the whole group -47.71 years. The results of the authors' own research concerning demographic data of the patients are similar to results obtained by other authors, such as Østerås et al and Kottmann et al [22,23].…”

“…Analysis shows that multi-organ injuries and head injuries were the more frequent causes for HEMS missions in rural areas. In Sweden, a study carried out by Kornhall et al concerning HEMS missions in rural areas, showed that the main reasons for the missions were injuries, chest pain and sudden cardiac arrest [23]. In Norway, similar results were obtained by Østerås et al in their study concerning HEMS missions [22].…”

“…McCowan et al in the USA concerning the patients with blunt injuries transported by HEMS crews, revealed that the values on the GSC and trauma scale were higher in patients from rural areas, which indicates a milder clinical status of these patients [28]. The study conducted by Kottmann et al in Switzerland concerning HEMS missions to patients with body injuries showed that the clinical status of the patients was mild and moderate (NACA 1-3) [23]. Studies by Kornhall et al concerning HEMS missions in rural areas in Sweden and HEMS missions in Norway conducted by Østerås et al, revealed that the average NACA score was 4 [22,29].…”

Patient and rescuer safety: recommendations for dispatch and prioritization of rescue resources based on a retrospective study of Norwegian avalanche incidents 1996–2017

“…It is worrying that multiple victim scenarios are so common. In a recent study by Kottmann et al [26], 32% of all rescue operations had more than one casualty. This phenomenon should be addressed in both emergency response and accident prevention.…”